Another day, attempt #1

[ken1300]

Off to hospital, again, this Friday for another infusion of Remicade.
Last Friday was rather painful having 7 attempts to canulate me and a failed ultrasound procedure, 8 all up. My previous record was 5.

Rather exciting then the Sonographer withdrew the needle, he had hit an artery.

 

[ken1300]

Well today kind of went well.
2nd attempt via ultrasound with the Radiologist.

Only problem is when we took the bandages off this arvo, to remove the cannula, my arm now looks like Popeye's.

One huge bulge in my upper arm :shock:

I wish I was an alcoholic.

 

[Jennifer]

Most attempts I can remember are 4. Here they have to have the patient's permission to try a third time and most wont try for a fourth but I told her to do it. Least she got it that time.

So did your arm fill with fluid because the IV wasn't in right or due to swelling from too much poking around? Also I don't get the alcoholic comment.

 

[ken1300]

The nurses where I go are GREAT, they normally strike "oil" within a few attempts.
They are allowed 2 tries then pass me off onto another nurse.
The doctor then tried 3 times to cannulate last Friday before the failed ultrasound procedure.

Every time I give bloods I have the same problem, not only bloods for my “normal” blood tests, but for additional PT tests from a private company.
Was so sick of having to go from collection centre to collection centre every time, I bought my own PT / INR tester. It's just like a blood glucose tester, it only needs a drip of blood.

This time I think I suffered Extravasation, the Remicade leaked into the surrounding tissue.
It's not sore at all but looks quite impressive. I actually saw the Doctor hit the vein, watching it live on the monitor, a perfect placement.

So after spending 7 hours in hospital, (normally around 4 hrs all up), to find a rather swollen arm, I come out to find it raining and a parking ticket on the bike then arriving home wet. Hence the reference to alcohol, I don't don't touch it, but some days ????

 

[annawato]

Sorry to hear of your troubles Ken. I'm also very hard to cannulate - they usually put a picc line in as soon as I turn up at the hospital - and its now got to the point they are having trouble putting picc lines in even with ultrasound.
Cannulas often tissue (extravasate?) with me. Once one tissued with the fluid they put in during a CT scan - that was incredibly painful, my arm and hand blew up like a balloon then turned purple and stayed like that for a few days.
I've also got a lovely large mark on my arm that looks like a bruise but is actually staining from an iron infusion tissuing. My GI said it should disappear in about 8 years. (!!!!)
Did you find the swollen arm painful? Did it last long? And did you get any remicade in you?

 

[ken1300]

They placed the cannula where a picc line normally goes in and the plastic tube was about 50mm long.

After I returned home and about 2 hrs after the huge lump in the arm, it decreased in size about 1/2.
Went and had a shower before bed it had dissipated .
The was no pain at all until last night in bed, a bit of bruising and tender this morning.

The doctor thinks that the treatment may be less effective and left it at that. No "double" dosing. The remicade infusion bad was 250mm volume and they think about 1/2 entered the arm.

I'm just about to go back this am to pick up some paperwork, I'll show one of the nurses that was there yesterday.

So it looks like I'm going to ultrasound before each infusion now and not complaining. Yippeeee All ready booked in for 2 months time.

 

[afidz]

Not sure if you have already discussed this, but have you considered a port? It may be easier on you since you have to get regular infusions and this way you don't have to get stuck a million times before each infusion.

 

[ken1300]

Hi,
The Radiologist, the doctor who performed the procedure did mention a port ??
Said something like having something like a PICC or Central line implanted under the skin of my chest if that's a port ?
Something may happen like that during my next hospital stay / reversal operation.
I'll still have the problem of getting blood out for blood tests, poor Phlebotomists lol lol.

Only 2 doctor visits this week, yahoo

 

[afidz]

If you had a port, you could do blood draws as well. It is definitely something to consider in your situation. I'm on my phone right now, but when I get back on my computer I will get you some information on all three so you can be educated before you decide which is best for you

 

[ken1300]

Could be good.
I would think a "port line" would have to have anti-coagulants in it, so they would have to flush it quite a bit before they can draw bloods.
I don't think the normal Phlebotomist at the hospital could do that ??? Definitely not the girls at the private collection centres.

I'll ask the questions when I'm there tomorrow, where I go for my infusions.
May just have to be admitted as a short term day patient for 1/2 an hour ???
Could be worth it.

 

[afidz]

Here is info on the port:
http://en.wikipedia.org/wiki/Port_(medical)
Here is info on a central line:
http://en.wikipedia.org/wiki/Central_venous_catheter
and here is info on a PICC line
http://en.wikipedia.org/wiki/Peripherally_inserted_central_catheter

I knew someone with a port, he loved it because it was low maintenance and he didn't have to get stuck a million times a day. In the US, all nurses are trained and know how to access them (as far as I know, never met a nurse that didn't). It only has to be flushed when its being used, other than that you don't have to do anything to it. However, it is something that is surgically placed, so keep that in mind.
I have had numerous PICC lines. Those are placed by radiology. I am not sure exactly how long they can stay in place. They do have to be flushed regulary to make sure it doesn't clot.
I personally have no experience with central lines so I can't give you any advice there.
I hope you are able to get one of these options so you don't have to worry about it anymore. I too am a very hard stick and its frustrating when they poke you over and over again and even when they do get the vein it doesn't last. Good luck with your appointment tomorrow, hope this info helps

 

[ken1300]

I remember I had 2 Central Lines.
The first one became infected, it can happen.
I remember having it removed but can't remember having the second one inserted, must have been drugged out.
Thanks for the links, I'll check them out and ask questions tomorrow.

Cheers
Ken

 

[afidz]

How scary having a central line infected? That could get really bad really fast. How did they figure out it was infected? Was there puss coming out of the area or something? I am no stranger to infection, but I never had an infection from an IV or anything

 

[sanni]

I have had a port and it was very easy to use. But here nurses are not educated to use them and I think I eneded up being an educational patient for ½ the nurses in one hospitalunit and some more at an other ( I moved to a different city so thats why a change in hospital). Also a nurse that knew what to do can take blood from it but I dont think a labratory person would. But it is something you have to know what you are doing with. To flush it very well after every use and put heparin in it too. Atleast with me this is how it was done. First saline then heparine.

I had it for almost 2 years and then for no reason it got infected. Some pus was comming from where the needle was inserted to the port. This resulted in a long hospital stay where the port was removed and the wound let to heal. I was lucky the infection did not get into my blood stream. However I have heard people can have the same port for even 10 years. So I just got unlucky with mine (or lucky since because of that hospital stay I got new doctors on my case and feel better today with out the need of a port).

Not saying this to scare you. All of those options mentioned by afids have risks in them and its good to know about them. I would take a new port any day if that would be something I needed. It was definately so easy and I was able to do a lot of my care at that time myself at home.

 

[Kimberly1967]

I had a port many years ago. I was hospitalized and it was placed in a surgical procedure right in my hospital room. It had several lines so all meds went through it. I also received TPN through it. It was up near my left shoulder and was held in with a couple of stitches. It was wonderful and was not painful at all. I would recommend it, however, it is a surgical procedure and subject to infection so you need to weigh the pros and cons.