IV'e Got Veins, Maybe

[Tom Galli]

I'm stuck.  Often as it turns out, and I'm more than a decade away from active treatment.  My veins, or what is left of them, run away and hide when in proximity of one of those IV devices.  I'm down to about 4 scheduled draws a year.  When in active treatment, I'd get poked that many times a week.  What results from all of this mayhem -  an irrational fear of blood draws.

Needles and injections are a piece of cake.  While in the army, we got vaccinated frequently, before every deployment, on a just in case basis.  We had a thing called an official shot record that was faithfully recorded each vaccine but it was never consulted by army medical authorities.  You just lined up for the assault by "jet injectors."  Everyone would walk the line and a medic would grab each arm, dab with an alcohol swab, hit you with the jet injection, and tell you to move on.  But there is a vast difference between an injection and an IV insertion.

My first year after diagnosis, IV insertions were relatively easy.  Sometime during my second year of treatment, missed insertions became common place.  Moreover, even successful IV sticks often failed to deliver the infusion.  Could it be callouses?  I often went through 3 or more nurses trying to install a functioning IV.  Once, they needed to call a CT technician to the infusion area because I used up every nurse in the place!  Further, I once had an IV installed in my foot!

Hospitals are the worst place to get an IV.  Unlike my small cancer treatment clinic, where everyone knew my name and IV history, hospitals proclaim: "we are the experts".  They proceed to stick and wiggle while inflicting high trauma, all the while saying "now sir, just relax, we know how to do this"!  I hope I have time to make a large "Summon the Hard Stick IV Team" sign before my next hospital admission.

Lessons learned.  I've acquired a few.

Most important, if you are offered a port before chemotherapy, get one.  If not offered, then ask for one.  A port settles the raging IV storm.  Drink lots of water before the stick.  Start drinking days before, not hours before.  Tell the medical "professional" to use an inflatable blood pressure tourniquet in place of one of those thin rubber devices.  Warming an area with a heating pad is nearly worthless unless the area is iced first.  And, the heating pad must be tightly secured to be effective.  Lidocaine patches work well if applied to a candidate area about 30 minutes before the stick.  I've had some success with the aerosol freeze spray that is now in widespread use.  I also take a .5mg Xanax about 30 minutes prior to a stick but my wife drives. 

Do not go quietly into your next IV stick session.  If you are paired with one of those hearing impaired medical professionals who says "we know best" after you tell them you are a hard stick and they miss.  Complain!  Loudly!  You are paying for all this madness, even for every miss.

Stay the course.

Tom

 

 

 

 

 

[Susan Cornett]

Being a hard stick is no fun.  My oncologist didn't want to insert a port since I only had 4 treatments and he said their infusion nurses are the best.  Fast forward to chemo #2 and SEVEN sticks to get a vein.  When I had my CT at the beginning of July, they weren't able to inject contrast dye after five sticks.  For my thyroidectomy a couple of weeks ago, the nurses brought in a doctor and an ultrasound machine to find a vein.  Just another adventure!

[Meloni]

This thread needs to be reactivated, especially for the new people coming on. 

If you or your loved one has recently been diagnosed, ask about a port for chemo! It's been such a godsend for me. I've only had four chemo sessions to date, and my oncologist recommended I keep my port "indefinitely" for now, in the event we need to do more in the future (lo and behold, this may be happening soon). I hardly notice its presence, and the only maintenance it requires is a flush every 4-6 weeks. 

My port has been used my port for chemo sessions and for the in-between hydration sessions. So much better than a stupid IV. I still get vein stuck for contrast imaging and outpatient blood draws. Also, if I go to the hospital, and somebody isn't port trained or seems fishy with their training, I don't let them touch it. Use your best judgment on that.  

[Barbara H.]

GREAT ARTICLE!!!!!

 

where can I get the aerosol  freeze spray??? that sounds like something that would definitely work for me!!!!  is there a brand  name??

[LexieCat]

My oncologist had a note right on his outline of the various treatment plans saying "will probably need port"--even before I asked about it. He also told me that since I have such a great relationship with my surgeon, he'd have him install it. Which, believe it or not, gives me something to look forward to. I totally love my surgeon. I wish I could have him handling all my treatment--though I know my medical oncologist is far more qualified to make the treatment decisions at this juncture.

[Tom Galli]

Barbara,

Freeze spray is what the chemo nurse called it. It was an aerosol spray in a can and was very cold. It likely had a topical anesthetic. You’ll need to ask your physician or nursing staff if they use it. One cannot purchase it. 

The nurse would find a good candidate vein and then hit it with the spray. Then installing the IV was a piece of cake. 

But if your treatment includes infused chemo, your best solution is a port as described in Lexi’s post. 

Stay the course. 

Tom

[GaryG]

My oncologist did not want me to have a port. I am scheduled for a 3rd and fourth round already all through IVs. Luckily  IVs never bother me and there is hardly a trace of a needle in my arm the next day.  My oncologist even talked about a maintenance schedule after the 6th infusion and you would think   a port is more suitable for that as well as blood work.  I wish they followed a standard. 

[LexieCat]

Did your doc say WHY they didn't want you to have a port? Was it something specific to you, or they just didn't like ports in general?

[Tom Galli]

It was specific to me and my treatment complications. 

[LexieCat]

I was actually asking Gary, since he said his doc didn't want him to have a port.

[Babs]

My story with ports is I can’t have one, even though I would love to. I have SVC syndrome and the vein they would put the port in is the one obstructed. I have asked both here and now down at the Mayo and they both say no!  I did have a PICC  (2X) during my first treatment and that was kind of a disaster.  Developed blood clots and they finally took it out after it only worked less than half the time.  I will be at their mercy with the needles and IV’s, but it’ll be OK.  
 

Gary - Sounds like you are doing fine without one, then so shall I
 

Babs

[GaryG]

2 hours ago, LexieCat said:

I was actually asking Gary, since he said his doc didn't want him to have a port.

Actually there are no physical limitations that I know off preventing  me from  having a port.  Maybe my oncologist was not sure what type of treatment to put me on for the long run. That does not make sense either because I don't have any biomarkers, can't have radiation or surgery. Next time I see him I will ask. 

[LexieCat]

My veins are about as hard to get as Tom's--and I have never even had chemo! In fact, the worst part of the bronchoscopy, for me, was getting the IV in the hand. Like Tom, I've also had my foot tapped. Those hurt WAY more than arm punctures and if I had to deal with that every day, or every few days, it would be pretty distressing. I'm not particularly afraid of needles, I'm just averse to repeated punctures looking for a vein and then being stuck in odd/painful places. A port sounds GREAT to me!

[BridgetO]

I'm with you on that, Lexiecat!  I had chemo for my prior non-lung cancer. My veins are hard to get, also. I can't be stuck in the left arm due to lymph node removal and radiation in the armpit, so all sticks have to be on the right. Those right arm veins , which were hard to stick anyway, are now pretty scarred up. if I ever need to have chemo again,  I'm going to ask for a port.  Cross fingers that I won't need chemo again!

[Lisa Haines]

To Port or Not to Port!   My thoughts and experiences --

I am a Stage IV Lung Cancer patient/survivor now at 6 1/2 years since my diagnosis and I have had my port (Port A cath) now for over six years and can NOT imagine cancer treatment without one.   I should also say that I was a person who was always considered a "hard stick" which meant that blood draws and IV's were always very difficult and quite uncomfortable for me.

In my case and at my local hospital they use my port for routine lab work, infusions and also for the IV contrast dye needed for CT Scans.    And even though I'm now out of treament and no longer having infusions, I'm still very happy I have my port.  I do go in for routine "flushes" which is very important if you port if not accessed on a regular basis.  For me it's now scheduled every 6 weeks - prior to Covid it was every 4 weeks, but after and during Covid, when people were far more concerned about going in to hospitals, they did some research and found it was perfectly safe and fine for most people to have flushes every six weeks and in some cases even every eight weeks.  I would not recommend going any longer than that, but this is something you can discuss with your team.  

I've also had surgery three times (non cancer related) and they used my Port in the hospital for my IV's, for Anesthesia and anything else I needed.   Truly a blessing for me because before my port every IV or draw was so painful and often required mutliple sticks, extra bleeding and bruising.    One trick I did learn (thanks to my neighbor who is an IV Therapy Nurse) is that IF you are a hard stick and you do not have a port, please tell your team about this and instead of becoming a pin cushion, it's fine for you to advocate for yourself and ask that an IV therapist professional starts your IV.   They are typically readily available at any hospital.  Not sure much in a doctor's office, but it is something I learned to ask for and it made other IV's and lab draws so much better.   These folks do this ALL day long and they are the best and finding a vein.    

Another thing to mention is that there is specialized training required for those who do and can "Access" a Port.  Not every phlebotomist has this training and a port should never be accessed by someone who is not specifically trained in Ports.  It requires a special prep and also a Heparin Flush.  A simple alcohol pad is NOT at ALL sufficient and it would be very risky for some to access your port without the proper training and following the proper protocol.    A port is a "Central Line" and requires special care.    I have found at that at my hospital the tech in CT are NOT allowed or trained to access a port, but they will happily call in someone from Oncology or IV Therapy to due so.  The same applied when I had surgery.  The regular OR nurses are trained to start a normal IV, but not port access and in those cases they did need to call in the IV Therapy folks, but it was never a problem and they were happy to do so.   If uou have one, using it is best and there is no point in having someone stick you 3-4 times, when you have a port!

My Oncologist has told me I can have mine removed, now that I'm not having infusions, but I said "No Thank you".    For one thing I feel it would be a jinx and for another and more important I love having it and how much easier it makes blood draws and IV's!    As long as it continues to work well, is being flushed or used on a regular basis and is not causing any problems, it's fine to keep it and that is my plan.   I LOVE my port and it's a keeper.

NOTE:    Ports also need to be surgically implanted by a surgeon, often a vascular surgeon.  It's a pretty simply and short procedure in most cases you will be "sedated" and now aware or awake during the procedure.   It can be tender for a few days, but quickly heals and can be accessed pretty quickly.    I also use a "numbing cream" on mine, called EMLA which is provided by my Oncology Center.  If not provided, most Oncologist can write you a prescription to pick up some at your local drug store.  It contains Lidocaine and makes a Port stick painless.  My Port has always been a bit sensitive and without the cream it can be a bit more uncomfortable, but it's also very brief and there are times I forget to use the cream and it's still fine, but for me it's better and totally painless if I use the EMLA topical cream https://www.webmd.com/drugs/2/drug-2358-8170/emla-topical/lidocaine-prilocaine-cream-topical/details) .    I typically apply the cream about an hour before any access and then cover it with a clean "Tegaderm" type clear dressing, which are also provided to me by my team, but can be purchased online at places like Amazon (https://www.amazon.com/3M-Tegaderm-Transparent-Film-Dressing/dp/B000PYP5R4/ref=pd_bxgy_img_2/133-1918719-2708145?pd_rd_w=HXO9Y&pf_rd_p=c64372fa-c41c-422e-990d-9e034f73989b&pf_rd_r=T28VXK5QS0B5EHDTBB03&pd_rd_r=0a2cb494-7f77-4b5d-966b-61f1821630f9&pd_rd_wg=etcPC&pd_rd_i=B000PYP5R4&psc=1)  and at some drugstores.    Port is also a shortened name for "Port-a -cath" and you can find a definition of a Port-A-Cath at this link:    fhttps://www.cancer.gov/publications/dictionaries/cancer-terms/def/port-a-cath  There are a few companies who make them and I have what is known as a "Power Port" which is important as you will need a Power Port if you plan to use it for Contrast for your CT Scans.  A PowerPort is a type of port which can withstand higher injection pressures that are needed to receive the CT contrast dye.    To the best of my knowledge, most ports are now "Power Ports" but it's a question you may want ot ask before you have one implanted.  

[LexieCat]

Lisa, you're fortunate to be treated at such a cooperative facility. The place where I'm being followed for my trial will NOT use my port for anything but infusions (though I do now have an order from my doc allowing the port to be used for CT contrast--the lab will NOT use it for lab draws). And this is probably the biggest hospital in South Jersey and home to an MD Anderson Cancer Center. That's one reason I still have U. Penn on board for any oncology stuff. They use the port for labs, scans, and infusions. No big deal--it's a matter of course. 

SUPPOSEDLY (according to Cooper Hospital) there was a study of some kind showing an increased risk of infection when a port is used for anything but infusion. I ain't buying that. If it were that dangerous, Penn (a highly rated NCI Comprehensive Cancer Center) certainly wouldn't be doing it. Ordinary good practices by well-trained staff should make it perfectly safe.

I don't know whether at some point I'll have mine removed (assuming all goes well with this trial). For now, I have to travel to Penn for accessing/flushing of the port, so I'm continuing to get infusions of Zometa every three months. My oncologist felt that was a safe interval. 

[Judy M2]

Like Lisa, I feel like having my port removed would be a jinx, so I go in for flushes every 8 weeks. I actually forgot all about port maintenance last year but my port still works fine. Another reason I want to keep my port is I'm allergic to the adhesive on Steri-Strips and I don't want to get those itchy blisters again.