Drawing blood from LE arm

Budsy

I have bad veins also and my LE arm/hand had to be used.  I was also told that as long as they do not use a tourniquet it would be okay.  That's been over two years ago and no problems from that.

Hugs!!!

Sandy 

Hi:

I've been seeing a lymphedema trained physical therapist for prevention of lymphedema, post-surgery and post-rads.  She said the first sign is usually if your ring feels tight on your hand.  Also she told me she just had a new patient.  The woman had breast cancer 20 yrs. ago and went to the dr.  Even though she requested that they not take the blood pressure on her "bad" arm, the nurse told her not to worry because her surgery had been so long ago.  Now she has developed lymphedema because of it.   I am just going to refuse all needles and blood pressure cuffs in that arm no matter who tells me it doesn't matter.  I believe there are at least two people on this board who only had 2 lymph nodes removed and have developed lymphedema.

Peeps

Buds, I was thinking about that same question yesterday when a phlebotomy tech was probing around on my good arm.  She did find a vein she liked, and got it with just one stick.

When I heard and read last year about not having blood drawn from the arm on our surgery side, I assumed the risk was infections or phlebitis from the needle stick.  I'm still concerned about that, because some phlebotomy techs don't do a very good job of cleaning the skin before sticking in the needle.  Sometimes their efforts are so minimal that I think it would do just as much good if they waved the alcohol swab in the air over my arm.

Now, I think there are more issues than just the needle stick.

You mentioned one problem:  the use of a tourniquet.  I've had blood drawn (pre-BC) without a tourniquet, and it wasn't difficult. My veins are easy to see and feel, so I'm usually an "easy" stick.  Even so, the techs at my cancer center use a strip of latex-like material (like a Penrose drain) for the tourniquet, and they tie it so darn tight!  Sometimes they don't even flatten it out--they let the edges roll so it ends up like a narrow tube.  There've been time that the imprint of the tourniquet was still visible on my arm several hours after the blood collection.  What if that was my at-risk arm?

The other concern I have is related to the tourniquet. For some reason, the techs at my cancer center do not use band-aids to cover the venipuncture site. Instead, they wad up a piece of gauze, press it over the venipuncture site, and wrap some narrow "Coban" around the arm 2 or 3 times to hold the gauze in place.  Coban is that bandage material that stretches a little and sticks to itself.  The problem is, the Coban ends up right over my elbow, and to keep it there, they wrap it way too tight.  As I move my arm, the edges of the Coban roll, and the whole thing ends up looking like a rubber band wrapped tightly around my arm.  What if that was my at-risk arm?

BTW, I had only 3 nodes removed during my SNB, and none contained any cancerous cells.  Even so, I've developed LE in my hand and forearm on that side. 

Chocolate surely does help. 

otter 

Hello, all -- what a lively discussion! Can't resist adding my 2 cents even if most everything has already been covered.

Petelzmom, I hear you on the fear of exercising. It's not just you and me, either. I think that's a really common reaction, as I've heard other women mention it too. The more I've found out about the lymph system, the easier it is to get over that fear, but it still hasn't gone away completely. The fact is that when we move our arms the muscle action actually helps to pump the lymph fluid, so basically exercise is good -- even necessary. But of course repetitive or strenuous exercise can also draw lymph fluid to the area, so we do have to be extra aware of our how our arms and chests react. The size and appearance are important, but so are any feelings of tiredness, strain, achiness, tingling or numbness, which can all indicate early stages of fluid accumulation, even before any swelling is visible. If you experience those things, stop and elevate your arm. You can go back to that activity later or the next day, but always being aware of how it's feeling and stopping if you notice those feelings. A well-fitted compression sleeve and glove or gauntlet (fingerless "glove") can help prevent fluid accumulation and maybe allow you to feel more comfortable exercising.

Peeps, good for you!! It's your arm, and your risk of lymphedema. But it sure can be hard to hold out against the insistence of hovering medical personnel. So, hang tough!

The labs where I get my foot draws all have had policies of not doing foot draws, and they've stated that to me. So then you say, "Yes, I understand. Do you have a phlebotomist who knows how to do foot draws?" And, "What day this week will s/he be working?" When you show up on that day (with "Draw from foot only" written on the lab order by your doc's office) you request the phlebotomist by name. I really have no idea why this works, or why they tell you they don't do it, when in fact they do. Must have something to do with potential law suits. I've even asked if I'm the only one they do foot draws on and they always say no, they have others they do regularly. Completely screwy! Maybe someone who works in this setting will happen along and explain this to us.

Sandi and Tami, I completely understand what you're saying. My doctors assured me of the same thing. I had one node removed with a L mastectomy, and a prophylactic R mastectomy with no nodes purposely removed, and I have lymphedema on both sides. Where lymphedema is concerned our doctors sometimes tell us hopeful things, but they can be misleading. Development of lymphedema can be cumulative, so that an activity that didn't cause it once, or twice or whatever, may eventually tax the lymph system. I wish we understood why, and I hope someday soon we will. But for now -- the risk remains. What you do about it, of course, will be your own best compromise with a very dicey situation. If I'd known I really was at risk, I'm not sure I'd have done anything differently anyway. But having lived with lymphedema for several years now, I wish I'd had the information (and the guts!) to take precautions.

Geesh, how long-winded! Sorry!

Be well!
Binney

Dawn, it's mind boggling how you could have bilateral ALND and not be told: did you ever check with the surgeon to clarify the discrepancy? No wonder your trust was shaken.

  Good point that labs will draw from the foot if it's in the order

Kira 

@holes." That seemed to be what I experienced: from the surgeon who introduced herself, said "Well, it is cancer, but you sure didn't give me much to work with here." And then got angry and defensive when I developed LE.

  I teach a course for medical students and we watched a video about patients and their families who experienced medical errors that caused great harm, and only one physician sat down and expressed his apology and concern--the other families were still experiencing a lot of anger and grief.

  I think, unfortunately, that medicine is fragmented, and surgeons aren't normally comfortable with patients who are awake, or need on-going care. I always quote Atul Gawande--a sensitive surgeon who writes great books, on surgeons: "Frequently wrong, never in doubt."

  There's a term in psychiatric medicine: ego-dystonic, when you act in a way that contradicts your idea of your idealized self, and it causes great distress. When a surgeon is confronted with a less than ideal outcome or a patient in pain (how dare you not heal well and quickly!), it can be ego dystonic, and it's easier to get angry at that difficult patient.

  I once had a sinus surgery by a national expert, and his discharge papers said that all his patients did well--seriously--and bad patient that I was, I got a bone infection and he refused to ever see me back. I saw my local ENT, who had to do two more surgeries and I was on antibiotics for a year. I never did report the expert to the medical board, because I was feeling so lousy. But all his patients did well, so obviously it was my fault and it wasn't real.

  Dawn, it's only natural to be angry. I've found that writing it down is helpful.

Kira 

hi bnney4 gosh l had both my arms used as every time l had chemo (FEC 6) in my good arm, the left side l had phybtis so on the last but one( 5th session )they had no choice but to use my right arm, the right side l was aware of LE but my onc assured me these girls knew what they were doing in the chemo room, l will say l was scared but did not seem to have a choice, then l had to have blood drawn off in a cannula in the same arm as they could not get no blood out of the right one, this is the first time l have heard of foot draw, but l will mention it to my onc, l aslo have  carpal tunnel, l have had the left hand done and have to have the right hand done and l am scared but it is to painfull now and needs attention, The left hand is fne and what releif, but was taken off arimdex as complaints of the same side effect had be known, what signs are LE as l will keep a close obsevation, thank you

l

My Dr. told me about drawing blood from the left arm (affected side).  Unfortunately the Nurse messed up and did not get the vials that needed to be full drawn first so I had to let her use my left arm, did not know about the tourniquet thing.  Not sure if this is the time I started having problems with the neck, shoulders, arm and foot (left side is where is affects me the most). 

 Thanks everyone for mentioning the tourniquet, I really had no idea.

Well, I had blood drawn today and had no problem getting the lab to use my foot, despite the fact I had been told that it was against their guidelines to draw blood from a foot.  I had the doctor write instructions to draw from the foot on the lab orders.  I also made a point of wearing my compression sleeves, which I don't always wear.  I think that helped - it reinforced the point that my arms were off limits.

Binney, my strong suspicion is that the tech who told me it was against the labs guidelines to do a foot draw didn't know how to.



Thanks for the good wishes! The blood work was just routine stuff, for my annual physical with my pc doc. I figure I have to see him at least once a year if I want him to give me the referrals I want. So far he has been very cooperative about referrals to the le clinic and approving jovi packs, etc. I found out his mother had bc and le, so he understands.

Otter, good for you--one stick limit!

When I was getting radiation, they had weekly blood counts, and the phlebotomist was terrible, and by the time I figured it out (it was SO important that when she was on vacation for a week--no blood tests!) she had essentially ruined my formerly great vein in my good arm.

So, now I go back to the lab I trust, and tell them that although it looks big, it's a mess of scars and only a butterfly will do--and it does fine.

I'm kicking myself for not refusing the in-house CBC's and going to "my" local lab.

I had to have surgery about 2 months after radiation was over and the anesthiologist said the vein was too sclerosed for an IV, so she used my hand.

Is "Susan" ever coming back to your lab?

Kira 

Dawn,

I too have met some jerks thru my two cancer journeys and they have been fired.  You hire these people to do a good job.  Maybe they do a good job but if they won't listen to you and what your problems are w/out a smart comment or turning their back then it is time to find someone else.

I get blood draws in my c clinic.  Also  both my primary and Onc office, hospital do my BP on my calf.

I know it has been a while since this post but I came upon it.... The reason why laboratories won't draw blood without a doctors order is because the foot is extremely susceptible to infections... It's painful and always a last resort... I have been a medical technician for 11 years... Phlebotomists are all trained to draw blood from a foot ( at least now they are). But it is very uncommon for one to come along... That's why they always try to avoid it and are hesitant.. The technician or phlebotomist can be terminated if they draw blood from a foot without a doctors order.



Also. If you're uncomfortable with how a phlebotomist prepares their site, do not hesitate to speak up. I have seen some lazy phlebs and it's not safe.. Especially if they are drawing from our bad arm..



It is also ok to ask how much experience they have had... If you have difficult veins filled with scar tissue, you will really love that experience lol



If the tourniquet is bothersome ( It always bothers me) it helps a lot to have them put it over your sleeve. It doesn't effect how the vein pops up.



Best luck to everyone!!