No bps/needles in arms...what to do in surgery
I have that hysterectomy coming up in November. Don't feel like calling the dr. for this one, I can wait til surgery to ask or when they call the day before.
I am not having any needles in my arms. Has anyone else had surgery with no bps/needles in the arms? I get the bps in lowers legs, but where do they put the IV needles. It's a nightmare trying to get an IV to begin with. Took the anesthesiologist a half hour to get one in my for mastectomy and she said that was her last needle try and if she didn't get it, she was going to shunt me just for surgery.
Comments
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Mycinnamon, I've had IVs in my feet. This is discussed a lot on the Lymphedema board here and other women have had them in their neck. That sounds horrible, but they pretty much agree it's not bad.
The real trick is to keep everybody away from your arms while you're unconscious and recovering. The G-sleeve is a good option (or make one yourself from a length of stockinette tubing):
http://www.g-sleeve.comWishing you smooth sailing!
Binney -
Thanks Binney. I would think the foot would be out because even though I will be staying in the hospital a night or two, I am sure they want me up and going to the bathroom.
I have given what do I do while unconscious. I don't need a sleeve, but I figured either I write NO BPS/NEEDLES IN ARM on each arm before surgery. Either they could do it BEFORE I am knocked out so I can see it, or I'd do it. It's a shame we have to worry about what they do to us while we are out isn't it?
The neck seems like a painful but better choice than my foot.
Thanks for the help!
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Cinnamon, some women write that on their arms with permanent marker (it comes off later with alcohol) and then have their doctor sign it!
Binney -
Cinnamon: Hoping everything goes smoothly for your surgery. Knowing what a wuss I am about needles, I am sending extra prayers your way that they get it on the first stick. Please keep us posted.
I have a question myself. I had a big sign in the hospital at the time of my BL MX for no NS BP's on the left. I thought it was because of the injured, I would later find out, broken wrist on the ca side. Do you know, nobody said Boo about no BP's or NS in future on the ca side. In fact the blood draw at the cardiologist's office and the first blood draw at the 4 mos checkup at the Onc office were both done on the ca side and I did all of my at home BP's on the left ca side. My best veins are on the left so I have always just offered that arm. It was probably at least 8 mos later that I read about it somewhere. Knock on wood, I do not have lymphedema. Just how likely is it to cause problems or lymphedema? If the insurance approves I should be having a surgery coming up to remove the The Mutants (dog ears) in the center of my chest. The left ca side has so few symptoms in comparison to the proph side which has alot of nerve damage that my internal barometer would want to protect the proph side even though there were no lymph nodes removed on that side. Still, now that I know, I have stopped offering the left for blood draws and am only doing BP's on the right. So don't worry, I will be cautious and not stupid about it. Just wondering what the percentages might look like on this issue.
Barbara
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Barbara, unfortunately nobody knows what the percentages are from a research standpoint because it's not a subject that's ever been studied. Some people who have had bilateral surgeries and want to continue to use their arm instead of a foot or leg, offer the arm with the fewest number of nodes removed; others offer their non-dominant arm (since lymphedema in a dominant arm is harder to deal with and more limiting). It's a tough choice.
The current thinking by researchers in the field is that about 40% of women who have been treated for breast cancer will eventually develop lymphedema. (Because more women are surviving breast cancer these days, more of them are developing lymphedema, which can show up at any time post-treatment, even years later.) So I guess what I'm saying is, it's your call. With bilateral surgeries both arms are at risk, the one with more nodes removed probably at more risk (though other factors affect risk as well). You can insist on their not using either arm, but they're likely to roll their eyes and tell you it's not a "real" risk. But in fact the risk is yours, not theirs.
Best suggestion available is to ask any doctor on your team for a referral to a well-trained lymphedema therapist for base-line arm measurements for future reference, personalized risk-reduction assessment, and possibly fitting for compression sleeves and gloves to use prophylactically for travel, exercise, or any unusual activities. Here's how to find one near you:
http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htmNo easy answers to this one!
Be well!
Binney -
Thank you Binney - I appreciate all of the info. A lot to consider.
Barbara
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They put my IV into my port during pre-op for my uni-mx a year and a half ago.
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I had a BMX and SN biopsy. Was told afterwards no need to worry about any blood drawing or B/Ps. I've not had a problem. If I had LE I would use the aoter arm.
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I had the IV in my right foot ans BP done on my left leg when I had my Thyroid cancer removed...I was able to get up and walk around without any issues (I was slow but steady) - My LE is very early stage and well managed however I absolutely dread flare ups and will do everything possible to avoid them...
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Babs, there is a movement within the medical community to discredit lymphedema risk reduction practices. It's not new, but it seems to be spreading, and it is not based on any actual evidence at all, just on the convenience of health-care providers. So it's certainly your call, but it's worth looking into yourself before you decide how much risk is too much for you individually. I, too, believed what my doctors told me, and I developed lymphedema in my left arm and chest (only one node removed) after a blood pressure on that arm, more than three years after my surgery. If it happens to you, the risk is 100%, and it's for the rest of your life. Here's an information page addressed specifically to doctors and nurses about this issue of mythologizing the reality of our risk:
http://www.stepup-speakout.org/essential%20informat%20for%20healthcare%20providers.htm
You might want to copy it off and discuss it with them at your next appointment.
Stay well!
Binney -
Hi all--been a while since I posted
I had a zometa infusion via foot last Tuesday. Only two nurses at my onc who know how to do it.
While we were chatting, they said they had man with a double mast who asked if anyone else had foot draws and and infusion. They said only one patient -- me--insisted on it. While they would do it of requested they preferred not to.
I said hey guys this is pain in the butt for all of us but let's rather be safe than sorrry!' -
Babs, I read in your profile that you're a nurse, married to a physician, perhaps you'd like to read information for health care providers on lymphedema--please know that the experience of one person can not be extrapolated to be universal--so glad you never got LE with a SNB, but I did, as did the two women who posted above me
http://www.stepup-speakout.org/essential%20informat%20for%20healthcare%20providers.htm
Lymphedema Myths and Falsehoods:
3) Risk reduction behaviors are myths: they have not been proven with randomized, double blind placebo controlled trials, due to ethical and funding issues, but clinical experience has validated that they are reasonable and should be taught to patients, staff and adhered to as medical practice. Patients remain at risk for life-studies of axillary node dissection patients show that the majority develop lymphedema in the first few years after surgery, and then at least 1%/year develop it, so that the incidence at 20 years of follow up is 50%. The triggering event that overwhelms lymphatic filtration capacity can be minimal and should be avoided.
I don't care how low your risk is (mine was quoted at 7%) when it happens to you, it's 100% and whie sharing our experiences is invaluable, I'm sure you wouldn't want to put women in harm's way, when a simple risk reduction behavior can lower their chances of developing an incurable, chronic disease.
Kira
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I've had a bilateral mastectomy, plus radiation and total axillary dissection on the right, sentinel-node biopsy on the left. I always try to get the blood drawer to use my ankle or foot, but usually encounter resistance. I've been told that your your chance of infection is greater from a foot or ankle blood draw, since your circulation is not as robust there and it's also a dirtier area (closer to the ground, more prone to fungi, etc.) I still make a stab at it every time, but tend to give in when the going gets tough. So far I haven't developed lymphedema, but I know I have all the risk factors, so I know I'm just lucky.
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I had bilateral mastectomies and lymphnodes removed form both armpits and developed a deep vein blood clot in my right arm.Immediately the Dr said no IV's,Needle sticks,BP's in my left arm.that was before the blood clot. they did BP,blood draws,IV in right arm during and after surgery.well thats the arm I got the DVT. anyways now they say only use my left arm for blood draws,IV's etc,BUT no BP in either arm.BP is done in legs,which by the way always reads high,always had low BP before.Last 4 surgeries I have had the anesthiologist has had to get the IV.In march this year for a zometa treatment 5 tries. they have destroyed the veins in my left arm but my ONC said to stay away from my feet for IV's blood draws etc because he said if i were to get another clot he would rather it be in my arm than my leg.so I plug along and DREAD bloodwork and IV's everytime I know they are coming up. I did get EMLA cream from my DR for this last zometa last week and blood work and used it and didn't feel a thing. so far all these needle sticks in the left arm I have had no issues with lymphedema,I do however have issues with cording.
Dee Oh, I have genetics blood clotting disorders so anytime they go in and out of my veins I am at risk for another clot.
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Cinnamon,
I just had a "Da Vinci" lap/vag/hysterectomy last week. It was an emergency surgery. I do have lymphedema, and my PT had given me neon pink wristbands to put on my wrists for such an occasion ( No BP, needles/ blood draws etc). They have a snap button, so it is reusable. I also wrote on my arms with marker, and then my surgeon allowed me to wear my compression sleeves into surgery. I think that got more attention than anything. I have learned to ask...and have discovered that people do respond.
Best of luck. PM me if you like.
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Dee, yes, a blood clotting disorder would be a contraindication for using the foot.
The neon pink wristbands that Cinnamon mentions are available free at Peninsula Medical:
http://www.lymphedema.com/alertband.htmAn even better help is the G-sleeve that covers the whole arm, but these are not free:
http://g-sleeve.com/Be well!
Binney -
Another gal here with LE in both sides of my trunk, yet only one sentinel node taken from the right side, none on the left. Having thought I would never get LE having such a "low risk", I was sure surprised when I did. I had two surgeries and several blood draws without getting. I have no idea of the precipitating event.
I had surgery in April and had a neck IV. While I was freaked out about it beforehand, it turned out to be no big deal at all. Actually less painful than arm or hand. -
Tina, how long did you have the IV in your neck?
Last year I had some revisons done to my chest to remove dog ears and had planned on a foot IV. But, they (couple different people including the surgeon) made 5 or 6 attempts but weren't able to insert the thing into the vein to complete the IV. At that point, while they were holding the operating room I was faced with the decision to have the IV in my hand or reschedule the surgery so they could put it in my neck. I let them use my hand and they removed the IV very quickly after surgery.
I need to have knee replacement surgery, but have been putting if off mainly because of the IV for surgery plus worrying about having to use my arms more than normal for rehab. I think for the knee replacement, the IV would need to be in for a couple of days. Would that be hard to bear if it was in the neck?
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Sher, sorry I am so late in responding. I stayed overnight in hospital one night and the neck IV was in place until discharge. It was inserted easily. I found it was much more comfortable post-surgery than the arm or hand IV had been. Either in bed or when walking, there was much less pulling in the neck and it was easier to do things with my arms and hands without worry of catching the tube on something. I could have handled it a couple more days without a problem. The anesthesiologist definitely has to be comfortable doing a neck IV. When I have discussed having this done for other procedures, some offices and hospitals made it sound like it was dangerous and they could cut your jugular. Apparently there are smaller veins in the neck that are easy to access, so it is more a matter of doctor experience and comfort with doing vs being extremely dangerous. You will need to request a neck IV at the time you schedule your surgery so there are no surprises the day of surgery. Good luck! Don't let them bully you into putting your arm at risk for LE.
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I had a colonoscopy last December and they tried to start an IV near my collarbone (I think). But they couldn't get a vein. I can't get IVs in my feet or ankles because I am diabetic. My ONC when talking about blood draws says, "ya gotta do what ya gotta do" so I get them on my left side (I am right handed). Also, my PCP insists (!) on taking my BP on my arm so I get it on my left side. When my BP is taken on my calf, the reading is always higher. So I personally am also concerned with high BP and want to know what it truly is. It seems useless to take BP on calf! I ask them to wait until I've been off my feet but they don't listen.
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A pain clinic nurse told me that to get a more accurate reading, the head should by laying down and that the longer I am laying down, the more accurate the reading. I don't get blood pressures on arms not nececcarily because of lymphedema, but because of severe PMPS. I can hurt for over a week after the bp from the nerve damage from node dissection. As soon as I go into the room with the nurse I tell them I am laying down for a more accurate bp. They can ask questions while I am laying down. I have only had one nurse (and surprisingly it was at the pain clinic give me grief), and a couple have been caught off guard because they didn't know that tid bit of knowledge. But all others, were glad to learn that and accomodate me. The last time I had my bp taken, it was normal! It will tend to read a bit higher and the medical staff documentating it should put it in your chart how they took the bp.
Btw, I have naturally really bad veins. In order to start IVs on me now, an anesthesiologist has to do it with an ultrasound. You may want to try that when you need an IV. My family dr. is ordering it during my pre-op visit next month for my next surgery, and alerting the surgeon, so I don't have to be argued with and think they can poke around where ever to get it in. I have learned to be very assertive with this stuff.
My PMPS is the driving force with the bp's. I really don't have an option unless I get no bp's. The pain from it is too bad.
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WinterStorm,
I tell them I have to lie down 5 minutes for BP on my leg, then I lie down. They ask questions and so on, and then take the BP, which is always just as low as normal for me after lying down. If I have to argue with them, I make them wait until I am calmed down. If the BP reads higher than normal in your leg, then it is not accurate, and they do not know what they are doing! You do have to be very assertive with some people, but this is the way to do it. Good luck!
Dawn
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Great advice ladies! When I've gotten my BP done on my calf, I alway would be sitting up. But now it makes more sense to be lying down because when you get it done on your arm, the cuff needs to be at the same level as the heart ...something like that anyways. Thanks!
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Thanks Tina! I will definitely inquire about a neck IV if I get up enough nerve to have the knee replacement surgery, or any other necessary procedures. Seems to me that with your hands and arms all free from attached cords, it would be much easier to navigate.
WinterStorm, I had problems with blood pressure readings too. Even though I was lying down for 5 minutes the readings would still be higher in my leg than what was usually normal for me. I purchased a wrist bp monitor and carry it with me to doctor's appointments to use on my least at risk arm. My bp is normal, so I don't need to do the measurements often - just for checkups. When I had surgery for the dog ears, they used my calf and informed me later that the readings were a little high. So leg bp readings can be higher than normal, the problem seems to be just how much higher than normal and if the doctor is comfortable accepting those higher readings. Before I got the wrist cuff, my doctor kept trying to put me on high blood pressure meds!
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