IVs and other sticks
I've had really bad experiences with getting IVs while in hospitals for in-patient and out-patient procedures and also with blood draws every place except the oncologist's office.
The problem is that I have excellent veins in the LE arm and have tiny veins in the available arm. I only allow them to use my non-LE arm, as instructed by LE therapists. The expereinces are SO BAD though (12 sticks, 8 sticks, neck sticks...) that I want to allow them to use my LE arm.
Yes, I always tell them the problem beforehand and ask for their best person and ask for ER nurses, etc. It doesn't matter usually. I'm simply a very hard stick in that arm.
I understand the potential risk in doing this.
However, I've just gotten out of the hosptial one more time, after 5 trips in past 3 yrs, and can no longer bear the stress and pain of these experiences.
What I want to know...
Have you had personal experience with allowing use of your LE arm for IVs and sticks? If so, I'd like to hear the good and bad, esp. if in recent years.
Thank you so very much.
Comments
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Manatee (not sure how you chose that screen name, but I love manatees
), we can only do what we can do--beyond that we make our own compromises.But even then we give ourselves the best possible chance for a good outcome. If you're going to use your LE arm, it's better to use it for blood draws (where you're not adding anything) than for IVs (where you're adding fluid to an already compromised system, which may not even be able to deliver the IV contents predictably or effectively). Feet and neck can be used for IVs (as you seem to have experienced), and if you use them right off the bat instead of trying your "good" arm first, the whole process will be less painful and stressful.
Keeping your LE in excellent control will make using that arm for any purpose less of a potential problem. Afterward, keep a close eye on it for infection (even delayed infection, as cellulitis can "percolate" before making itself known). Elevate your arm, stay extremely well hydrated--basically, follow all the guidelines for a flare even before you have one. Plan to visit your LE therapist as soon as possible after any "insult" to your LE arm, for extra treatment and evaluation, as well as management tips.If after using your LE arm you do develop an infection, or even intractable new swelling, then you'll need to reconsider. But for now, considering the distress you've had to deal with, please don't beat yourself up for trying less-than-ideal ways to manage your healthcare needs. LE is bad, but it's not all we have to deal with, and sometimes it just needs to take a back seat to other considerations.
JMHO. Please keep us posted. Gentle hugs,
Binney -
I don't have LE...but I dont let them use my right arm......
MO did it once because it was getting impossible to draw blood
Once he drew blood from the hand...I didn't like that.......
I have been told to Drink plenty of fluids before blood work so veins will be visible
Good Luck
Sheila♥
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I'm not sure what you are saying - you were 'stuck' 20+ times at one attempt with no success? But then they immediately got a good vein in an LE arm? There are SO MANY sites in the body to use. When really dehydrated it does become a problem but even then a Dr can cut in and establish a line.
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Manatee--I am in the same boat as you are. My right affected arm was always the best for blood draws and IV lines. I have to have blood work up every six months for my oncologist. Six months ago after many sticks and many blown out veins in my left arm and hand they called my PCP and asked permission for a foot draw. It almost did not work but finally did when they called someone else in. I was dreading the bloodwork I had several weeks ago. Six months ago she told me to drink a lot of water for 48 hours before and a lot of water that am before draw. She was able to get it out of my left hand--one stick--so hydration seemed to make a big difference. My Dr. left a standing foot draw just in case. My PCPs lab does my bloodwork and sends to my oncologist. I once asked at the oncs lab what they would do if they could not get blood out of my left arm and they said they would use my affected arm without tourniquet. The PCP lab does not even consider my right arm. Oh, and they put heat on the back of my hand before drawing. My blood also drips out so slowly when they do get it that they keep having to shake the tube to make sure it does not clot. So I understand all of your frustrations. Binney gave you some great advice. Don't worry excessively over it.
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Thank you for the feedback, everyone. I appreciate the understanding and compassion of those who have been there. And Binney your perspective is most helpful!
Until you have had a foot or neck draw it's hard to understand what it's like. Or having 7 different people poking on the same non-LE arm and hand over and over. Or finally getting an IV in and then having it fall out several hours later and having to start all over again. That's the time I had 12 sticks on one arm.
It's hard to be hydrated for surgeries because one has to stop liquids hours earlier. All I can do then is ask for an early app't so I'm not as dehyrated as I would be later in the morning.
I've had 4 hospital visits this yr., along with various blood tests out-patient and it's overwhelmed me.
Thank you,
Donna (went to Manatee High School in Florida:-)
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As long as we're discussing bloodwork prep that makes blood draws easier, I'll mention my routine.
Surgery's a special case, since you go into it already thirsty.
For that I don't take their "No water after bedtime" or "after midnight" at face value but check with the surgeon about EXACTLY how many hours before surgery I have to stop drinking. Not only do I guzzle water the two days prior, but I set my alarm for the specified time and get up and drink all I can hold then. Otherwise it can be waaaaay longer than is actually necessary, especially if you're not scheduled first thing in the morning.
For blood draws, I checked with my doctor about taking aspirin beforehand--thins the blood and really helps it flow. Since I'm bilateral, I have a footdraw order too. I make sure to exercise (walking, jogging--gets the blood flowing) before going, wrap my foot in a microwave heating pad (being careful not to get it to hot) for the trip there, and in the waiting room keep walking or bouncing my leg up and down--everybody looks at me like I'm crazy, but it really helps. Legs stagnate when you're just sitting there.
I always ask to lie down. For some reason they don't always think of that themselves, but it's much more efficient for them than bending over my foot and trying to reach all their supplies. They can lay everything out right there. I switch the heating pad from my preferred foot to the other, just in case the first draw fails and they need another foot. Then, for some reason, I've found that deliberately relaxing all my muscles makes the whole process much easier. Not only hurts less, but it seems to make the vein access easier, too. So I concentrate on slow abdominal breathing and relaxing.
Don't know how much of that is actually physically effective and how much of it is just a ritual that soothes me
, but...whatever helps!Donna, were your sports teams called the Manatees? They're such noncompetitive creatures it would be about like one of our community colleges here whose athletic teams are The Artichokes. Goooo, Manatees! Goooo Artichokes!
Be well,
Binney -
If you want to use your good arm/hand for IV's but medical staff find them too hard to start, have the anesthiologist do it with an ultra sound. Before I stopped all IVs in both arms, thats how they got it done.
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A couple of months ago, I had the same frustrating experience of multiple sticks on my good hand. The anesthesiologist finally did it, after four aborted tries by a nurse who kept telling me he had never had such problems before. Hrumph! Two days ago, in my local and very tiny hospital, I was gritting my teeth for yet another adventure, in the preliminaries for a colonoscopy. Well, to my surprise, the nurse got it the first time. Certainly skill made a difference, but I had also used Binney's strategy of setting my alarm for the 6 hours prior to surgery, drinking 24 oz of water, so I wouldn't be so dehydrated. The nurse who called me three days ahead of time, to go over colonoscopy prep, had suggested that to me. It turned out that the entire experience was quite LE-friendly--everyone understood and was incredibly accommodating of my LE needs.
I think the lesson learned for me is to call ahead and speak to someone about the LE problem. In my case this last time, it was standard procedure for a nurse to call, but I'll take the initiative going forward. Often there's that one nurse who is simply the best at starting IVs, and I'll make sure that they know I'll only tolerate one failure before calling in that person. We really need to speak up and be firm in these matters.
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I just posted about this on the Moving Beyond Cancer thread! I recently allowed a blood draw out of the LE arm. I had a BMX, but 32 nodes removed on the right side. However, the veins on the left side have been completely wiped out by chemo. The only time they can find a good vein is when they use local anesthesic and good to town digging around with a pediatric needle. Since the typical lab doesn't offer this service, blood draws have become a source of great anxiety for me. So, when my OBGYN mentioned that he wanted to check hormone levels I just about cried. At that point I decided to let them use the LE side. It was wonderful ...one barely perceptible needle stick. That was a week ago and I havent had a flare up yet. I won't use this side for IVs but I will be using it for all future blood draws.
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As always, our wonderful Binney has helped us out with rock-solid information that is the perfect combination of science and common sense. Thank you, Binney. Have we told you lately, just how much we appreciate your steadfast presence in the LE forum? And Cinnamon, thank you for that great ultrasound suggestion. I had no idea that was possible!
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I'm having a bone scan in the morning which requires an injection of radioactive material. It's the first time I'm having one since my prophy mx. I've been extremely careful of that arm since the surgery even though no nodes were removed. When I made the appt I asked the secretary to check if they can use my port. She spoke to the doc, who at first said no, so I said to the secretary, Oh dear, that means they have to use my foot. That was weird enough for her to go get the doc, and when I told her why she reluctantly said they would use the port as long as I went to the onc dept first to have it accessed (not a problem). In case they decide tomorrow that they don't want something radioactive to go through the port I'm going to ask to have it done on my foot or neck. If they can't do that and use my at-risk arm, does anyone know any precautions I should take after the injection? I'm planning to ask them to clean it with alcohol immediately afterward and I'm bringing bactroban ointment and a bandaid just in case.
Thanks!
Leah
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Leah, I had a bone scan with my initial work up, and it was a bit of an irritating dye, as I recall. Hopefully, they can use the port.
Just keep it clean, and you stay hydrated, and put antibiotic ointment on it, and limit tourniquet time.
Good luck
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Excellent tips and advice. OH how this thread hits close to the bone....or should I say vein. A miss is as good as a mile. grrrr. I am SOOO Sooo sorry for any of you who have issues with blood draws IVs etc etc. NO body gets it unless theyve been there on this issue. I have had so many dramas with this I cringe at the thought of my next appt and what it's going to entail.
One of the many episodes Ive had was when I was in Onc ward for being neutropenic after 1st chemo, an incompetent doctor tried to do a foot draw and dug and dug and turned and twisted...... and failed. I was sooo distraught and angry I cried for hours and hours through the night. I went so far into orbit I can't even remember what they did or who they got to finally get one done.
After many issues and nightmares, earlier on this year I was able to have an official meeting with the appropriate people and my idea was to put forward that BC patients need to be given extra care when it comes to BP, draws etc. OK some DON'T have issues and I'm happy for them, but some us DO! My reasoning was that other patients get the equipment and services pertinent their needs, why not BC patients who veins are tricky! This is NOT a case of being demanding and wanting favouritism as some might imply, but a NECESSITY. My veins are such a problem I was able to recount and put forward how beneficial it was, when I had a procedure which required an anesthetic, the anesthetist very easily got a vein in my foot using an US and with a local A. It was sooo wonderful.
So, I have all needles done out of/into my foot. There is a nurse who is very good at blood draws and as long as I'm lying flat and do what she says, there isn't a problem, but anything that goes "in" they have agreed to allow me the afore said service. As for my my prophylactic Mx side, its curtains due to chemo and everything else it's had to endure like BPs. It's still saying enough!!!! No more. My BC side seems to be doing much better then Prophy side, which is deemed as having "suspected LE". They even did my final chemo in the LE side.
Gentle hugs to all who fight this monster.
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I had lousy veins in my non-ALND arm BEFORE BMX, and discussed this with my BS before the surgery. I have one single vein in my right arm that can be used for blood draws, and she said it would be OK to use it, just take care, observe for early LE symptoms, etc. as advised above. I had to sign a little paper at the onc/infusion lab where I get my blood drawn saying I understood the risks, but it is MUCH easier than suffering 5-6 sticks in the other arm. I might feel very differently if I had problems with LE, but so far, this is working for me, and better than going to a foot draw for me. But being sure to hydrate prior to blood draws is excellent advice. Also, I wonder if it is better to use the antecubital vein in the center of the fold of the arm and forearm rather than a hand vein - seems to me there might be more possible damage and infection with veins that can roll or have valves or be easily missed or traumatized in the hand, and that one in the center of my arm just isn't going anywhere, it just sits up even without a tourniquet and behaves properly for the phlebotomist!
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My veins are also wrecked in my non-LE arm. Last year when the initial tech was unable to get blood, an experienced nurse came in to help. Prior to making her attempt, she got a warm compress and applied it to my arm at that elbow fold for a few minutes. That seemed to bring that vein out and maybe relaxed it? In any event, she was able to successfully get a needle in. Since then, I carry a couple of those hand-warmer packs to any appointment involving a blood draw. Before they stick me, I activate the hand warmer pack, then ask for a damp towel and apply that to the arm along with the pack for a few minutes. Sounds like your idea of wrapping your foot in a microwave warmer wrap, Binney. It really seems to help.
Good idea to ask specifically about water and how late you can have it. I know to guzzle water prior to routine appointments, but surgery mornings after fasting have always been hard.
Also agree on politely but firmly asking for the best person with veins after one or two attempts by the initial tech. I always make a joke about it and explain the situation, and ask for whomever is "The Vein Whisperer" on staff - the one person who always seems to be able to get a needle into difficult cases. It gets a chuckle, but gets me the best person on staff as well.
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I just got out of the hospital for a non-cancer surgery (bye-bye gall bladder!). My five day stay was filled with constantly reminding caretakers not to use my left arm. The sign they put up over my bed kept falling down, and of course, you can't take that to the OR. But I managed to do it! And thankfully, my mild LE is just where it was when I went in a week ago.
It was getting a little hard towards the end to find useful veins in my right arm...three IV moves and numerous blood draws. For some reason they had no interest in using my legs. Oh did they drool over the lovely veins in my left arm, out of their reach by my constant guard! I just stayed vigilant and kept offering them a leg when they looked at my right arm and tried to find a useable vein. -
Nancy, I cracked up over the "Oh did they drool...!" They really do, don't they? You can just see the little gears turning in their feverish brains: How can I convince her to let me do this? Just this once!
Brava for you for all that vigilance, and for the great LE result! Hope you're feeling lots better and healing well. Rest up! Be well!
Binney -
Ha ha on the "Oh did they drool"
LOL for warming the veins in my foot I stick it right up next to the heater in my car on the way to where I get it done. Works wonders in the winter...not so good in the summer with neuropathy and burning feet. I've also been known to use a wheatbag or hotwater bottle.
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I thought I might be overdoing the "notice" to my caregivers, and I remembered a story a friend told me about her hospitalization for flu and pneumonia. She is very attractive and had had a beautiful breast job done a few years ago...just a lift, but being in a teaching hospital, all the residents were coming by on rounds to check her breathing (and whatever else they enjoyed, lol).
She got so used to opening the front of her gown for them that when this one man came in she automatically started to undo it. She was a fraction of a second away from baring it all when she saw him pushing a broom around.
So I figured I wasn't anywhere near embarrassing myself as that! -
LOL LOL Nancy. As they say a miss is as good as a mile.... phew that sure was a near miss....
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greetings all....I have mild lymphedema (had lymph node removed prior to mastectomy) and have been very good with doing exercises, pump etc. Today my letter opener slipped and sliced my finger on the affected arm. Not a bad cut, more of a scratch, but did break the surface. I immediately put on antibiotic band aid. Should I be worried? What should I look for?
Thanks
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Oh, phooey, Hoya!
We didn't used to have to worry about stupid things like this, but with LEyou're right to be alert for possible problems. What you're looking for is cellulitis, a kind of infection we're prone to that can spread quickly. Information about what to look for here:
http://www.stepup-speakout.org/Emergencies_and_Medical_Care_lymphedema.htmThe other issue is a flare, which you'd treat with wrapping or garments, staying well hydrated, pausing for some deep abdominal breathing, and some extra MLD. (And of course keeping an eye out for cellulitis).
Most likely, though, if you washed it and applied some topical antibiotic, you won't have a problem. That's what we'll hope for!
Please do keep us posted on how you're doing!
Gentle hugs,
Binney -
I have the same problem though I don't have LE. Like Cinnamon said....for surgeries I now request an ultrasound to locate blood vessels and the Anesthesiologist hits it first time in the non surgical arm. US units are so portable so it isn't a huge request. Also, for just when they need a small amt of blood for a test....they will just prick my finger and keep squeezing till they get a right amt. Good info from all!!!!
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so far so good...cut is healing..no redness at all and no changes in arm...thanks for the info on celluitis...had a problem years ago on the other arm (pre cancer surgery) and ended up in hospital for 4 days with swelling, heat etc...they never could come up with an exact dianosis. No point of entry found...scary though when 6 different folks ask if you have a living will!!
Appreciate the info.
Kathy
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Kathy, whew!
Thanks for letting us know. Very good news--stay well!
Binney
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