Need some advice about sensitive veins (IVs and blood draws)

Fearless

Hi All, 

I'm a 69 year old survivor of HGSOV 3C since early 2017.  Recurrence in December 2018 and now on a clinical trial the past year and a half.  Outside of the standard checks and balances with this disease, and the IVs associated with my first round of chemo, the trial requires monthly blood draws and semi-monthly scans. I've always been an easy "poke" when it comes to blood draws and even IVs even though, apparently, I'm considered a triple threat (veins are very narrow, very deep and they move out of the way of the needle).  But I did notice toward the end of my chemo that it was beginning to become more difficult for them to get my IV inserted.  I thought over time that would improve but I'm now at a place where the mere thought of a blood work or CT scan gives me major heart palpitations.  The past six months it's taken multiple tries to find a vein and more recently, even when they do, the vein collapses mid draw or before scan dye can be infused.  My last scan required 7 tries, ended up with 2 collapsed veins, and then finally the vein they thought would work ended up blowing as soon as the dye began infusing.  That one left with 2ccs of dye in the soft tissues of my arm; fortunately not enough to cause any major pain or trauma but enough to make me want to run from my next CT next week!

I have tried all the tricks; over-hydrating for days before the scan,  warm compresses on my arms, balled up fists. Nothing seems to make them pop.  At my last blood draw this week it took 15 minutes to even find a vein worth trying!  Yes, if I have to go back into chemo I will insist on a port.  But for the sake of one blood draw a month and a scan every two to three months it doesn't seem reasonable to undertake that procedure.  

Has anyone else had issues like this?  What have you done to try to overcome the problem?  Love to hear from you....at least to know I'm not alone.  

Flowergirl

Hi again @Fearless; sorry you are having to deal with this, too! 
Hydration and warm compress are the only "tricks" I'm familiar with and on a personal note, I ended up with a nice purple bruise for about 2 weeks from a failed attempt last chemo session. (Warm wash cloth, several times a day and a gentle massage helped it to reduce and fade) I'm wondering if the treatment team at the cancer centre has any other ideas to share? Anyone else have any to share?

maggiemae

Hi @fearless, it sounds like you're going 'through the wringer' as they say with these IV's!  I've not experienced it to the extent you describe, but have had it take up to 5 tries to get the IV in during chemo.  Like flowergirl, I found that hydrating and heat helped, as did making a fist for a back-of-hand insertion or straightening my arm for a wrist insertion.  Apart from that, some of the successes might be a result of the technique used by the nurse or doctor? Maybe explain your situation and request the most IV-experienced staff member?  I lucked out on my second chemo series because they did insert a port in my chest and I must say, it made SUCH a difference! The port left a bit of a scar but hey!, with those we carry from our more major surgeries, these little scars are no big deal, LOL. I hope you have an easier time going forward and with a very positive study outcome!  Best wishes, M  

Fearless

Thanks @maggiemae My issue is now even with standard blood draws.  I expect the fact that they had to use gemcitibine instead of paclitaxel in my original chemo exacerbated already very tiny, deep and squiggly veins. Gem, is knows to be rough on the veins, although gentle in other aspects. If I have to go back to chemo at some point there no question I am opting for a port.  I did have to have another scan the other day and while it took awhile...even though I'd hydrated, used the bunched fist, warm compresses...they did finally get a vein and this time when they injected the dye it didn't blow.  Two new tricks I learned this time....never use a needle gauge bigger than a 22 and ask them if they lower the pressure on the dye injection.  Blood draw tomorrow in advance of my clinic appointment on Tuesday and the results of the CT scan I just had on Wednesday so wish me luck.  

devanator

Hello,
During my first go around with chemo, i opted out for port or pic, numerous pokes, many, many tries again. I was in emergency once and had to yell stop poking me. Finally a 4 person tried with a child intervenous needle. 2nd and 3rd diagnosis it was bring on the pic lol. Have a great day!

maggiemae

Hi @fearless and @devanator, thanks for sharing....those are good tips to know! (using a needle gauge no bigger than a 22, asking them to lower the pressure on the dye injection, as well as using a child intervenous needle).  How did you make out with your blood draw and CT appointment last week @fearless?  Cheers! M

Fearless

@maggiemae....the last blood draw was great.  A new girl so I thought..uh oh!  But she took one little stab and I was out in 5 minutes. Black and blue of course but that's usual for me these days. As for the follow up, good news that the nodule on the left we'd been watching has stopped progressing again.  Nothing new discovered and just my incisional hernia is larger and there is now a nodule on my right side that's progressed a bit.  So since nothing other than those showed up they think the pain on my right side is associated with the hernia. The nodule is so small (smaller than a pea) that it's unlikely to be the culprit.  So being scheduled for hernia surgery and they might whip out that nodule while they're in there anyway.  Still on the Olaparib for now since it's clearly still having some effect. So reasonably good news. The bad part is now waiting for the surgery and dealing with the pain in my side until then.

jiselle16

@Fearless You are definitely not alone when it comes to sensitive veins! Before cancer, I had no problems with giving blood (the lab techs would always remark that I had nice plump veins!). Now, even in my 30's, after 6 rounds of chemo, blood work and IVs for scans, my veins have shriveled up. When I went for genetic testing a couple of years ago, I ended up having to give blood and ended up in tears as the tech couldn't successfully access any veins and I was beyond frustrated. The poor tech thought she was hurting me, but really I was just frustrated with all of it - cancer, the side effects, the whole bit! It has improved slowly over the years, but my veins have never been the same unfortunately. My only tip is to make sure you are hydrated and drink lots of water before any blood work, but it sounds like you are doing all the right things! Glad you had an easier time for your last blood draw!

Fearless

Thanks @jiselle16, @maggiemae, @devanator, @Flowergirl....really appreciate the feedback and suggestions.  Sometimes it's the nicest is just knowing you're not the only one.......

maggiemae

Hi @Fearless, I'm so glad to hear that you had an easier time with your most recent blood draw.  Don't you just love it when things go well unexpectedly?  It's like receiving a small gift out of the blue, right?  Hopefully you'll hear about your surgery soon and things will remain calm for you (little to no pain) until they can get things taken care of for you. Hernias are no fun - been there.  Best of luck and let us know how you're doing.  Cheers to you and here's hoping your next blood draws follow in the same 'vein' as this last one! (sorry, couldn't help it :-).  Best wishes, M

CountryLiving

Hi. I was told by chemo nurses to hold off on drinking coffee til after needle insertion. Never had trouble after.

Fearless

@CountryLiving thanks. I'd never heard that one before and definitely going to avoid my morning caffeine hit next time. Hope that helps me like it sounds like it's helped you.  

BeamBlossom

At my final chemo treatment, the nurses told me that my veins, which were great when I began treatment, were now damaged and more difficult to get an IV into.  There would be mild recovery post chemo but they would never be as good as prior to the infusions. Caffeine undermines hydration, each cup of coffee cancels out 2 glasses of water I've heard.  The only other tip I've heard of is too ask for a new nurse if one is unsuccessful after 2 attempts, tell the team of this request before the first attempt so that you won't worry about offending the first nurse and she can arrange for an alternate to be available.  This strategy will go a long way to minimizing your anxiety about the Iv setup.       

angel27

my veins were terrible all the way thru. I remember being told to hold off on caffeine. Thinking of you 

Fearless

Well ladies, it does seem the "no caffeine" rule was helpful.  They easily found veins..the first hurdle. Unfortunately I had a novice who decided to poke the tinier one and as a result they could hardly fill the three tubes so on my way home had a call back because one tube coagulated. Fortunately I wasn't far from the hospital and the gal I got this time was a real pro.  She picked a vein that would have filled a bucket.  So that will be my new rule...no caffeine before blood work.  Thanks all.

tdubs17

I too have trouble with veins and needles.  I opted OUT of getting a port tho.  I put up with the multiple pokes, bruises and blown veins.  They used the blood pressure cuff on me and worked like a charm.    I also had the blood draws and chemo IV;s in my hands.  Good luck!

Fearless

@tdubs17 great idea with the BP cuff. Might just suggest that when I'm in for blood work on Monday.  But it also must have something to do with the skill of the phlebotomist or nurse. I was in for surgery a week ago and the IV needle they use for anesthesia is one of those big fat things so I thought....oh oh.  But she looked down, tapped my wrist a couple of times and said...little pinch...and bingo!  But yes, I find directing them to my hands works well also...they hate to do it because it does hurt more but I'd rather a few seconds of pain than 5 tries and failure each time.  Thanks for the suggestion.

tdubs17

Found a nice juicy vein on the inside of my wrist near my thumb.  Its painful but successful.

Fearless

Off for another CT next week and dreading the IV again.  But for those of you who might have a PICC line, I just heard from one of our community that they just did her dye infusion using the PICC.  I had asked about a chest port at one point and was told that has not been approved for the force of the dye infusion.  Never asked about the PICC..so there you go. If you're anything like me and IVs are problematic, and you have a  PICC line, ask about that as a possibility.

Jule_P

Hi Fearless. I have the exact same problem. I direct them to my hands or wrists first thing now, get them to bring the warm blankets and their best pokers. For injecting dye, they always do it manually, slowly, massaging gently the arm as they go. Oh, yes, and always the smallest gauge. 

ToughAsTeal

Last chemo was Friday! This time I tried the no coffee, ramped up the amount of water, nurses wrapped arm in hot blankets, even tried hot moist... no luck. 3rd nurse was successful in right arm.  I have always been given choice “do you want your left or right arm”.  Given I am right handed, and typically in chair from 815-3pm, I preferred to keep my right hand free, and always asked for left.  This last time, nurse said it ideally should  alternate.  Hindsight, I think I had read that when learning what to expect, but the brain just gets so full!  Oh... and the no coffee and water still helped tremendously! So thank you for that advice! 

kastoyles

The nurses always alternated arms with my chemo treatments. My veins are not what they used to be and when I have a blood draw, they sometimes have difficulty - even with the baby needles.

I found that lots of water before treatment helped tremendously, in more ways than one.