BP and needle sticks

kmpod · January 2014

Hi all,

I have some worries about my risk for developing LE. I had 4 nodes out on my right side and none on my left. However, I do have a number of risk factors - overweight, HBP and persistent post-surgical seromas.

I have a colonoscopy scheduled for next Monday and I'm concerned about communicating my concerns about using my right arm, in particular, for BP measurements and possible needle sticks.

I called the day surgery unit and the attendant told me just to tell everyone I encounter and that they were "usually" pretty good about it.

Has anyone gone to the extent of using a Sharpie and writing the instructions on their arm prior to a procedure?

hugz4u · January 2014

Welcome and good questions.

Yes a sharpie is an excellent idea. Write in big letters NO BP NO STICKS IN THIS LIMB. You still should mention it to the doc and attending nurse just before procedure.

My doc took my BP from the leg and used my ankle for needles as I have had dble mast. and both arms are at risk although one arm still has nodes in it.

Let us know how it goes for you.

Also my doc was not going to sedate me with my colonscopy and once he started I said it was uncomfy and he gave me the choice of sedation. Of course sedation was much better.

Anonymous · January 2014

Im in the same boat as Hugz but have suspected LE on prophy side as well as the real deal on the BC side. Ive also had a seroma on prophy side. If I seem over cautious, its for good reason TRUST ME. The trick with this is to deploy EVERYTHING in the book:

Just in case you actually HAVE TO FIGHT THE SURGEON OFF (and Im NOT kidding) you could:

1/ Use Sharpie

2/ Wear an OTC compression sleeve (make sure it fits well) and notify the team of this before hand.

3/ Theres those bright pink bracelet bands which are SUPPOSED to serve as a warning - no sticks and BPs

4/ Anything else you can think of no matter how radical. A padlock comes to mind here, but ideas on how to instantiate it would need some pure ingenuity.

carol57 · January 2014

kmpod, you're getting good advice here! Another strategy is to bring this excellent handout with you:

http://stepup-speakout.org/essential%20informat%20...

It's for docs, nurses, any other professional care provider, written by a physician who has LE after BC surgery. It's a no-nonsense explanation of LE and particularly strong on the take-the-patient's-needs-seriously topic. Read it, print it, and bring several copies; alternately, send it or drop it off a few days ahead of time with a note clipped to it that you will require arm precautions on your nodes-out side.

I had my bmx/snb/recon surgery at a major-city, med-school affiliated hospital and had to argue for arm precautions after waking up to learn that sentinel node biopsy required 5 nodes out. 18 months later I had a colonoscopy at my little, small-town community hospital and wouldn't you know, every single person there was full on board with my LE needs. So it's not predictable, and you are so smart to be lining your ducks up so you can protect yourself.

hugz4u · January 2014

Actually, I didnt write it

directly on my limb but sharpied it on my upper portion of my older sleeve.

When I do wear that old sleeve I kinda feel safe in it, if i was in an car accident the emerg team would see it and hopefully comply and not needle or bp me.

Dont forget our beloved josh from lymphedivas created a hospital sleeve and gauntlet in bright yellow with no bp and no stick symbols on it to wear. Check it out on the lymphediva website, its called hospital sleeve. Reasonable price.

Anonymous · January 2014

I can't imagine sharpie ink complimenting our LE experience when it came time to removal. :-/

a hospital sleeve and gauntlet in bright yellow with no bp and no stick symbols on it to wear

Sounds good! and as for that padlock, seriously, some surgeons are NOT beyond yanking your sleeve down to stick you.

kmpod · January 2014

Thanks for all your replies. It's nice to have confirmation that I'm not overreacting in my concerns.

I don't have time to get the hospital sleeve but I'll order one for future use and go with the sharpie this time.

And, thank you Carol, for that well written handout. I learned things from it and I'm sure that everyone I hand it to will as well - if they take the time to read it. I go for a pre-procedure ECG tomorrow and I'll drop one in at the day surgery unit, as well as my surgeon's office.

I really hate to think of spending the weekend doing "the prep". Oh well. so it goes.

Binney4 · January 2014

kmpod, there is also the G-Sleeve:

http://g-sleeve.com

and you can request a free LE-alert bracelet here (click on FREE LE-Alertband on the left-hand side):

http://www.lymphedema.com

One gal here wrote the prohibitions on her arm with a sharpie, then had her doctor sign it.
You might also want to ask the doctor to write it into his orders (though that alone is no guarantee), and be sure to mention it to everyone you see there.

Let us know how it goes! Be well,
Binney

carol57 · January 2014

kmpod, I really like that handout, too. The women who created step-up, speak out are amazing, and they 'met' here in this forum. Many of the rest of us link to resources on that site, because we have benefited from it so much.

hugz4u · January 2014

kmpod, Let us know your experience as we are all gleaning from each other.

Don't worry about wearing your arm out scrubbing off the sharpie and causing a swell, Use Body lotion to help fade it . When my LE girl marks me for my measurements with it and then I put my sleeve Atop, the sleeve wears it off in a few days. It may stay on for about a a week but thats all. If your not a sleeve wearer, don't panic it will fade.

For sleeve wearers: Regarding the lotion, put it on at night so it won't permeate your sleeves and wear them out. I use regular lotion at night and by morn I either shower it off or pop my sleeve on as the lotion is pretty well soaked in. My sleeves seem to wear pretty good with this method. Any more ideas?

wyo · January 2014

kmpod- I work in healthcare and you are not overreacting you are protecting yourself. It would be great if all caregivers passed critical information like this along but sometimes they are not reliable in hand-offs.

I would recommend you ask that this information be placed in your chart (paper or electronic) I would ask if the place you are going has a special band or designates information on your patient ID band regarding needle sticks and blood pressure. Tell every person who asks you your name and date of birth which side to use and which side not to use.

As far as the sharpie- where will you be writing it? Asking because a blood pressure cuff is a long way away from your hand where an IV may be placed want to make sure you are covered. If anyone gives you a hard time just tell them you know they are busy and information may not get passed along so you are looking out for your own safety

kmpod · January 2014

Thanks for the very useful information, wyo. I'll ask about any special band and make sure that it's noted in my record.

Would a "No IV" on the back of my hand and a "No BP or Needles" on the inside of my arm just below the elbow be good positioning?

carol57 · January 2014

I've had helpful nursing staff take an arm's length of some kind of tape and write all down its length no BP no needles, and then attach it from wrist to upper arm before I headed into surgery. I'm not sure how they would feel about having me arrive that way, but it was their idea to apply it and I imagine it was pretty hard to miss once I was in the OR.

NatsFan · January 2014

I had the same thing as Carol several times - a pre-op nurse took something that looked like regular masking tape and took a length that ran the entire length of my arm wrote "NO RT ARM PROCEDURES" on it. Also, when everyone came to see me in pre-op, I directly told my surgeon, the nurses, and the anesthesiologist in no uncertain terms that there were to be no procedures on that arm. Good idea to actually make sure they write it in your record.

Binney4 · January 2014

All great suggestions here!

I have tape allergies, so the tape wouldn't work for me. I write NO BP HERE on my upper arm, and NO IV on both the back of my hand and the inner elbow. The technical term is RESTRICTED EXTREMITY, so I write that down the length of my arm.

The ink comes off with alcohol, but make sure you then wash off the alcohol promptly and lotion well (alcohol dries the skin).

Since I already have LE in both arms, I always wrap both arms before procedures like this. But I write underneath the wrapping anyway, because we have had gals wake up to find their wrapping in a heap at the foot of the bed and a bp cuff pumping away on their arm. Grrrrrrr!
Binney

kmpod · January 2014

Well, I've just awakened from a nice long post-procedure nap.

As the story always goes, the procedure was a snap and the prep was hell.

I did mark myself up with a sharpie (or rather had my husband mark me up). I hadn't thought about how difficult it would be to write on my right arm using my left hand until I went to do it.

They were very good at the hospital. They put a red bracelet on me with my allergies identified and as a warning not to use the arm. When the nurse asked why I answered with one word - lymphedema. There was no argument at all.

I am very hard to find a good vein in - the nurse wouldn't even try and had the anesthesiologist do it himself. He got it on the third try and said he'd use my ankle if the last attempt didn't work. Thankfully it did.

Thank you to everyone with your good advice. I hope to not need another one of these for another 10 years.

BP and needle sticks

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