Pat’s Place: Tips For Infusion Days
I started my Velcade (bortezomib) / dexamethasone (Decadron) infusions again last week after recovering for four months from a stem cell transplant that I received this summer.
The infusion process got me thinking about ways I have learned to cope with getting “stuck” for IVs over the years.
Sure, I’m a lot tougher now than when I started treatment for my multiple myeloma almost five years ago.
Even so, it isn’t any fun sitting still while a nurse digs around in your arm, trying to start an IV and looking for a vein.
I have learned a few tricks over the years to help the experience be a bit less uncomfortable. I would like to share those with you today:
- Hydrate, hydrate, hydrate! Drink plenty of water, starting several days before your scheduled appointment. I have read it is best not to drink alcohol within 24 hours prior to the procedure. This may be good advice, but one could argue that a drink or two before you hit the infusion chair might help you to relax (I’m kidding, of course).
- Apply a warm compress to raise veins. Is it better to use a dry compress, or is wet heat okay? Either way, a warm, soothing wrap—applied 10 minutes or so before your IV—can really help those veins “pop.”
- Raise your arm up over your head for a few minutes. This is one of my favorite tricks. Simply hold your arm up behind your head for two or three minutes just before the “stick.” The blood rushing back into your forearm and hand will help pump those veins up.
- Shave your hand/forearm before your appointment. It doesn’t matter if it is the night before—or the morning of the appointment. Shaving your arm and hand might look funny, but it eliminates the worse pain of all—at least for guys—when your nurse or tech pulls the tape off your arm following the procedure.
- Ask your nurse to use tape remover “goop.” Tape remover liquid really works -- especially if your skin is sensitive and the tech uses the wrong type of tape -- or you forgot to shave. (See tip #4)
- Use a topical anesthetic cream. Yes, sticking an IV catheter through your skin/veins will hurt!! But there are topical anesthetic creams that can be applied to your skin to help numb the site.
- Bring an I-Pod type device with earphones and listen to relaxing music.
- Ask for pediatric needles. I saved the best for last. For me, the gauge of the needle is everything! A standard IV needle is a 20 or 22 gauge. Pediatric needles are 24 or even 26 gauge. Convince your nurse or tech to switch to a smaller gauge needle, and you won’t need a lot of these other tricks.
I understand that there are some arguments against using pediatric needles for an IV. Some techs complain that they aren’t stiff enough. Many hospitals don’t even stock them.
All I can say is, I haven’t had a bad “stick” in a dozen visits at my local infusion center. Why? The incredible skill of the oncology nurses? Nope. It’s the pediatric needles. Love them!
One last tip: Think about me the next time you sit down for an IV—and remember to feel good and keep smiling!
If you are interested in writing a regular column to be published on The Myeloma Beacon, please contact the Beacon team at .
Hello again Pat,
Read with interest your IV piece. Shortly after I was diagnosed in July 2000 a porta-cath was installed on the right side of my chest. Sadly that one became infected and put me in ICU. So it was taken out and another was placed on the left side. 10 years later that porta-cath is still going a treat! I will be at my Day hospital this Wednesday, sitting in the big chair with book and iPod handy, after having been connected to my infusion of Aredia. I'm just wondering why you haven't had a porta-cath yourself? Way to go!
Thanks for asking, Ken. Until I started getting Velcade infusions for induction therapy pre-transplant, I took oral Revlimid and had no need for a port. Since I was getting a central line for my SCT, we figured I'd wait. Line was pulled in anticipation of a lengthy drug-free holiday. How long will I be on once a week Velcade? Maybe I should consider it... Your port has really lasted ten years? And you can swim? Hmm...
Thanks for the tips, Pat! Like many of us, I've been 'stuck' hundreds of times. I started my weekly Velcade maintenance infusions (95 weeks down - 61 to go)with the thought that I'd go with an IV in the arm unless some difficulties arose that necessitated a switch to a port. So far there have been no problems. I alter arms and places on the arm from week to week and notate the location on my lab result spreadsheet. The infusion nurses always start by saying 'Where are we going this week?' Now, if something does go wrong, I feel armed (pardon the pun) with some great strategies from your list. I will share this with my Onc/RNs. Thanks, again!
Sounds like you have decent veins too, Sean. I feel so bad for many of the older patients when the nurses can't find a spot that works.
This week I was sitting next to a woman who couldn't produce any blood for a draw--can you believe that? They stuck her and stuck her and couldn't get a sample. Ouch! I started to give her some "tips," but fortunately she didn't need an IV that day...
Like Ken, I really like my port.
There is zero discomfort when I go in for infusions. But best of all, my arms are free, making it easier to read, get coffee etc. when at the infusion clinic.
Sort of off topic, but early on I asked them to stop giving me benadryl with my infusions. Once they eliminated the benadryl, I didn't feel like I was going to get a DUI on my way home.
Thanks Pat.
Pat, if access to your veins is a problem,, why not get the velcade subcutaneous. It is being given that way to some patients at the Moffitt Cancer Centre. That alternative is far less complicated and with none of the significant potential side effects that a pic or central line would pose.
Good suggestions, Stan and John. I don't believe I get benadryl in my IV...
I had an unfortunate site reaction to the sub-q Velcade. Part of it might be operator error at the small, local clinic where I get my infusions.
If I need to use Velcade as maintenance after the RVD brings my M-spike down and it stabilizes (I'm thinking positive!) that might be a good time to try again.
As others have indicated, these are a lot of good suggestions (hadn't tried putting my arm over my head, but had done most of the others). Another thing I found helped was to take a deep breath prior to getting poked, and don't watch. In the end though, I also opted for the port. Evidently, I have a lot of valves in my veins, and while they never had a problem getting into the vein, it typically took two or three tries digging around to find a place where they could get a good blood draw (I also have alergic reactions to the anesthetic cream, so that didn't help). I'm much happier having the port and the freedom to move my arms more freely, rather then having bruised arms all the time and the pain assoicated with getting the IV to work.
I hate when they dig around in there! Glad port is working for you. I'm just not sure yet if I am going to stay on Velcade long enough to need it--and as many have suggested, sub-q Velcade is an option as well.
Great suggestions!!
I have tiny veins and based on the ultrasound of my arms they did in vascular...they do not run in straight parallels like most of the population, mine randomly diverge and curve, lol.
This gives new meaning to God makes everyone special as poking me is like hunt and peck and even if they get in, nothing seems to come out after the first vial, when they need multiples...sigh.
O what fun it can be when God makes you unique!!
I am considering a port for that reason. I am apprehensive as I understand it is a surgical procedure requiring full anesthia. Also apprehensive about the increased risk of infection...however I have heard nothing but positive testimonials from those with them which means as usually...we have to go through the bitter to get to the sweet.
Eight cycles of continuing bruising and no outcome poking is making me lean towards that port.
First, I will try the topical anesthetic, along with ped needles u suggest...
Also, gonna bring my i-pod!!
Thanks again Pat
Hello Pat,
We are new to multiple myeloma. My husband 66 was diagnosed with it a couple of months ago along with Amyloidosis. He has a tumor on the 5th rib. They have started radiation on the tumor. He is also doing an injection once a month of Zometa, along with Revlimid. The doctors have told him as far as cancer goes this is a maintainable cancer and they are very positive. He is active and you wouldn't know by looking at him he even has cancer however I feel scared. I appreciate your columns so much I am learning so much. You inspire me.
I'm so glad to help, Sherry! So sorry you and your husband have to adjust to all of this. Your docs are right--but learning as much as you can helps a lot as treatment choices/options are presented to you.
Good luck! Pat
Hi Pat
I was diagnosed in Jan of this year and tthank god I am in remission after 5 cyckes of iv meds and a stem cell transplant this past may.I have horroble viens and I have a porta cath which works awsome! I highly recommend this.How are you feeling now after the stem cell? I have stiffness in my legs and wondered if you have the same? My doctor said this will get better.
My legs are back to normal. I believe the soreness comes from muscle loss experienced during the transplant recovery process. Your muscles need to work harder to get you going. I exercised a lot before, during and after. That seemed to help. So keep moving, OK!
Pat: Enjoy your writings....and information.
My husband has had his Infusa Port for one year. It's great for lab work, as well as Chemo. Eliminates that poking and prodding for veins, in an old arm!
Much luck.....keep writing, and keeping us informed.
Pat,
My wife is the Meyloma patient and I have been with her through the whole "trip" which began in 2005. Long story short, after three stem cell transplants [MM Cancer Center, UAMS, Little Rock, AR] and four years of Velcade, Thalidomide, Revelmed and countless other drugs, she is and has been in remission. Her doc, Dr. Bart Barlogie has been excellent and very agressive for this good result. However, as you and your readers all know, this cancer is relentless and that is why your web site and articles are so helpful as well as a friendly voice in the wilderness.
Currently my wife [whom I call my Iron Butterfly] is only having Zometa injections[infusions]every other month and we return to MIRT [Myeloma Institute for Research and Therapy} twice a year for a complete "look-see", PET, MRI, Density, full Labs, Bone Marrow and consult with Dr. Barlogie.
As you and your readers know none of this is really a vacation, however, things have been 'clear' enough for us to travel to France for a real break in routine. This started out as long story short -sorry, but it's gone on and on. Thanks, Pat, for your articles and others comments. And yes, KEEP MOVING.
Sending our best.
Forrest and my Iron Butterfly
I'm amazed this morning as I think about how many of you who are going through similar situations... It is hard! Glad we are all still here to share our stories and "complain" about it once in a while!
Forrest--Did you have to pay out of pocket for transplant #3?
I've had two (thanks BlueShield), but I wonder what they'll say if I come for #3? I could buy a nice home for the $210,000 each one costs.
Stan, We had to pay for transplant #2[which was much less that $210,000] and the third transplant was "called" a boost and covered by medicare. Each person has, as you know, a different version of Myeloma so I hesitate to compare too closely.
Believe it or not, if you shop around--and things go right--you should be able to undergo a SCT for under $100,000. Of course, that will buy a house with a pool where I live in Florida...
Pat,
The charge for Donor Search/Harvesting/Transporting/Processing of the Marrow were $100K for my Allo. Hospital stay on average for a myeloablative Allo is 30 days plus. Compare that to Autos that can be safely done on an Outpatient basis. I wonder why a lot of Insurance Companies view Allos as "Experimental Therapy" for MM patients???? I was fortunate my Insurance Co. agreed to pay for my Allo while I was in my first Remission.
Mark
Good point, Mark. Autos are a lot less expensive than allos. I have also learned costs can vary by 50% or more depending on the region and institution...
Get new Myeloma Beacon articles by email.