Lymphedema risk & TB test following BMX

coraleliz, why don't you ask if they can do it on your thigh or your back? The LE risk is real.

Best of luck.

Leah

edited to add: if they do it in your back it should be in the LOWER back since the upper back is part of the quadrant at risk for LE.

Coralez, the ppd test is adminstered intradermally--just below the skin, and when it's positive, there is swelling and inflammation--of course the ppd is absorbed, and then if your body has been exposed to TB, your T cells mount a defense and a positive TB test is greater than 10 mm of swelling and I've seen some whoopers.

Maybe it's only been standardized on the inner portion of the arm, but the T cells don't discriminate, they'll come after it on your thigh.

They can't force you to take a risk for this.

Tell them to call the CDC if they have questions.

When I googled "alternate sites for PPD testing" I got a pdf from Vermont Dept of Health which said:

Alternative sites such as the upper back 
or shoulder, or back side of upper arm, 
may be used when the forearms are 
inaccessible or unsuitable.  

And here's the CDC site:

http://www.cdc.gov/tb/

I know you're trying to avoid the upper quadrants, but if the upper back is ok, why isn't the thigh?

Kira

Wow, Kira and Coraleliz, this whole discussion makes me think: if the two of you, working in healthcare, have to push back so hard to protect yourselves, how does the average Jane stand a chance?  I'm also thinking of someone in another thread whose RO refuses to acknowledge LE even though another provider and an LE therapist says probably/evaluate it.  

Those of you working in healthcare may have a different view of what sometimes feels like a parent/child relationship, so you may be more comfortable arguing back when a provider is not being helpful or accommodating a true need. In the past I have found it easier to be a pushy advocator for my children than for myself.

Looking back at my own recent medical journey, I sure did let myself be pushed around before I woke up and realized that no one was going to protect me from LE mistakes and missed opportunities if I don't do it myself.  But even though I know this to be true, I still feel like I'm somehow doing something inappropriate when I challenge my various providers on their inadequate understanding of LE.  Sigh.  Kira, you should put on some 'challenge the medical establishment' seminars.  They would be sell-outs.  (Of course, probably not too popular with your employer!)

Carol 

Kira, it's only our own horses who are out of the barn, and at least that fact can alert the rancher before all the others get out too.<sigh!>

Carol, the key for me has been to take an offensive stand and start educating my providers. But it never ends. I've done in-service chats with my own med onc practice and the last time I went in for my flu shot there the nurse wanted to see how far up my arm the compression sleeve went -- if there was room above it she thought she'd give it in my arm. You smile nicely and set them gently straight. Again.

The StepUp-SpeakOut page about essential information for health care providers is here:
http://www.stepup-speakout.org/essential%20informat%20for%20healthcare%20providers.htm

Copy it off and deliver it to whatever person at your doctor's office is most likely to listen to you. If you want their attention, you might add a plate of brownies. (Brownies have multiple applications to the problems of LE!) Offer to talk to them about your own experience at their convenience. It's not a matter of shaming them for their ignorance (though that's tempting too), but of sharing their surprise at the things they were never taught.

Onward! (Okay, climbing down off my soapbox now!)

Liz, so glad that worked out for you. You might record the date of the call, name of the medical director, and notes about the conversation, so when it comes up again next year you'll have a precedent to show them. Or ask him to put it in writing to you for future reference.

Geesh!
Binney

Coraleliz, while the deltoid muscle is the preferred vaccination site for adults, the thigh is an approved alternative location. Here is an excerpt from the CDC's Vaccination Administration Guide on their website:

 -Adults (19 Years and Older)

For adults, the deltoid muscle is recommended for routine intramuscular vaccinations. The anterolateral thigh also can be used.

I have been getting the flu shot in my thigh for the last 6 years ever since my LE dx.  My PMD offers a walk-in flu clinic for his patients so I just call ahead and let them know which day I will be there. This is the first year they told me they would have to get a longer needle for an IM shot into the thigh.  I think I must be one of the very few patients they do thigh injections for and perhaps they reviewed the literature this year for proper protocol.

CDC quidelines call for use of a 1" - 1 1/2" needle, 22-25 gauge for standard IM shot into the Deltoid muscle of an adult.  A 1" needle is adequate to reach the Deltoid for most adults but 1 1/2" is more commonly used for obese patients or thigh injections.  I had no problem with them using a longer needle for my thigh even though I think the 1" needle used in previous years was adequate for me.  BUT I did object when the nurse walked in with an 18 gauge needle.  I told her that she was going to have to get a much smaller gauge than that.....18 gauge needles / IV catheters are typically used for blood transfusions and surgery.  There was no need to poke a huge hole in my thigh to deliver a vaccination.  She came back with a 22 gauge 1 1/2" needle which was fine.

Some resources I read suggested that the gluteus muscles should be avoided as an injection site specifically for vaccinations because you don't want to risk hitting major nerve bundles or blood vessels. The anterolateral thigh (vastus lateralis muscle) is an acceptable alternative IM injection site for both adults and children. Nursing staff must use their assessment skills to determine if their patient has reasonable muscle mass at the injection site, or excessive adipose tissue which may require they adjust the needle length accordingly.  Gauge pertains to the size of the inner lumen of the needle and since most vaccines are not very viscous, a smaller gauge 22-25 lumen is perfectly adequate.

http://www.cdc.gov/vaccines/recs/vac-admin/default.htm#guide

 So yes, we still have to continually educate ourselves and others to be our own best advocate. Changes for the better are coming....but still much too slowly!