not 100% sure why, but recently, since i've had a lot of cannulas in i have been really really struggling with them. I think part of the issue is that i find cannulas in my hands to be absolute agony (to the extent i cannot move my arm or hand at all, cant tolerate people even moving my fingers, sometimes cant stand due to slight changes in pressure in my hand, have cried like a baby having them removed etc.) and i have really good veins in my hand. In an emergency i can understand that they just want to put the largest possible line in, and in the easiest vein possible but no matter how many times i say i dont want cannulas in my hands they will really really push for it. Its got to the point that i gag even thinking about it, typing now im having to rub the backs of my hand to stop cringing. My elbow veins aren't great any more, if im well and hydrated then they aren't too bad, but in an emergency they can be hard to get at, which does obvs increase the amount it hurts.
The thing is, i feel silly, i really dont want to cry over a cannula, and obviously as i tend to need magnesium and IV hydrocortisone (and often fluids, and they like a line in in case i need aminophylinne anyway) so i dont really have a choice about it and i hate the idea that they think im making a fuss - i DO really try to be tough - i think my tolerance for them is wearing thin.
Anyone had any experience with this problem, or have any ideas to deal with it. The issue is the pain primarily, but also with doctors not taking my preferances into account (unless im really really desperate for meds NOW, i'd rather they dug around in my elbows or the backs of my arms than went anywhere near my hands). Currently my only way of dealing is by making all my blood tests be in my hands (in the hope of protecting my elbows and actually making my hands worse) but not sure if that actually works!
thanks for any tips!
ps. Does anyone know if Adcal-D3 comes in other flavours, tutti fruitti is really horrible and i hate taking it first thing, makes my mouth taste all gross for ages!
Its interesting that they still put them in your hands - in our local hospital they stopped doing it, as it prevents you washing your hands properly and thus potentially increases infection transfer risk. Our local hospital always puts cannulas in lower forearms above wrists. Papworth never use cannulas, but use longlines instead which are much more comfortable, and protect your veins better when they are being used a lot.
Veins scar when they are used a lot. I used to have veins which basically yelled 'come and get me' - all medics loved them lol. But because they have been used so much now, they are more scarred, and new lines being inserted / blood tests are much more uncomfortable. I try and rotate sites to ensure they get a rest.
Soph if its a massive issue for you and you know you are facing an emergency admission could you put some emla cream on your hands prior to going in? Or ask them to treat you with emla cream prior to inserting any cannulas? You can buy emla cream on the internet.
AdCal is gross, I told my GP it tasted like chopped sick hahaaaa. One flavour as far as Im aware....
what are longlines? I assume its not the kind of thing you can ask for - more of a varies between hospitals type thing?
Lower forearm, do you mean on the backs of your arms? I have had them there a couple of times, i think in one of my hosps they said they didnt like doing that, something to do with valves!?!
I do try to rotate, but i'm now at the point where i only have one site in my right elbow which is consistent, so that gets used a lot!
will deffo have a look at the emla cream - its a good idea, not sure why i didnt think of that!
Long lines are 8cm (I think) long tubes which are inserted into peripheral veins, and they have a little butterfly type end, so nothing really protrudes above skin level. Something called a bionector is attached to this, which is where drugs are given (just another bit of tube). They then cover this with gauze and tubigrip to keep it tidy and comfortable.
They are put in on the top of your forearm, or in your upper arm. Mine have always gone in forearm but its going to be upper arm next time as veins are getting scarred.
Lyndax
And on the subject of valves, your veins in your hands have valves too - all veins do, it stops blood pooling (as in varicose veins when valves fail). Thus it seems an odd reason...
The pictures are probably better than my explanations lol!
Thanks Nurse Furby - do you go home with them in? thats what the text with one link implied (or is it just that you CAN go home with them - but dont neccessarily?) how do they fit them? just like a normal cannula?
managed to get my prescription changed to lemon - gonna try them see if they are any less gross!
*I* thought all veins had valves - couldnt really talk to argue at the time - and didnt want to sound stupid! do they push cannulas 'forwards' through the valves or backwards?
Yes you can go home with them in - depending on how ill I am, sometimes I stay in hospital for the 10 day course, and sometimes I do five days in hossie and then do the other five days of IVs at home myself.
They fit them similar to a normal cannula except of course there is a longer tube to ease into your vein, but I still find them so much more comfortable
Good luck with the lemon AdCal! Lol
Don't know about the vein thing - I could theorise but I don't know for sure. The last time I had a normal cannula in the back of my hand was at our local hospital when I had my spine injections - normally I don't have issue with them, though its rare I get them. But it was absolutely excruciating and I had to ask him to stop, I was really embarrassed. He was apologetic and said if it was that painful, it may have been that the cannula pushed through a valve. It went in the back of my other hand fine. For weeks afterwards my knuckles and the back of my hand were numb so I think it caught a nerve. It's the only time I have one in the back of my hand, as its only in for an hour or so.
However they are unlikely to place any form of permenat access to people not needing long periods on amino from what you have been saying only in for 24 hours or so and not needing regualar IV theapy ie rregular doses of hydro, iv antibiotics for longer periods or long spells on amino. as it is a big infection and clotting risk and a bug in one of those can be deadly!
Im afraid its something you just have to put up with
I think they may actually be a lower infection risk with the longline/bionector, since they can stay in 10 days. Whereas venflons have to be changed every 3 days because of the risks. But I agree, they arent going to put a long line in for 24hrs, if for nothing else other than cost!
Interestingly Papworth also use butterflys for taking blood rather than normal needles, as they are more comfortable for people
The thing with long lines they go into a bigger vein and therefore have quicker access to the central cardiovascular, there is a bigger risk of infections like sepsis and septicemia, a cannula is an peripheral vein and therefore the risk of these big infections in next to nothing
Longlines vary. Mine is put into a peripheral vein above my wrist, and doesnt even reach my elbow, (its only 8cm) thus it is still in a small vein. It isnt a longer line/central catheter, they are PICC lines, (peripherally inserted central catheter) and yes there is a much bigger risk with those.
I did wonder about that, i wasnt sure which part of the process is the highest infection risk, i would imagine it to be the time they put it in - but dont know. If it is then its complicated, im cannulated very frequently for short periods (once a fortnight ish) so not sure where the lines cross over re infection of putting them in vs infection of keeping them in. Had to be cannulated tonight for fluids as cortisol levels ahd gone dodgy (and probs therefore also salts etc) and it wasnt too bad when i wasnt struggling to breathe as there was less rush so they were able to spend a bit more time finding a vein and it hurt much less!!
If just need Hydro you can have it IM
good grief, if you're cannulated fortnightly, youre gonna have no veins left in a few years... think I would rather have a longer term access device...
Its not usually just hydro, its usually also magnesium, and tonight it was fluids as well, they always cannulate me in A&E as they expect me to need at least hydro and magnesium and they like to have access for emergencies. I guess thats something i could discuss with GP/Cons to see if i can have a letter asking A&E to at least *try* to not cannulate me. Its always hard as i like to try to be compliant as i find that doctors and stuff can be really rude if you ask them not to/to do something (i even find they dont like me asking them to cannulate away from my hands so i can imagine it being worse if i asked not to cannulate)
i did wonder about longer term access, i guess im just hoping that they can get me more stable and then i'll need less IV stuff, a permenant line sounds a bit too drastic, but i do worry that im going to eventually need one coz my veins are already in a pretty bad state, they have ahard time seeing them for all the scars (i wonder if as so many are placed in resus in a more emergency-type setting tht maybe they are not done as well and so scar more??)
possibly worth discussing at some point, even if just to check that the way we are doing it currently is the lowest infection risk. Will have a think
Thanks for all the advice!
soph if you need IV fluids, magnesium and steroids, especially in an emergency situation, you will be on a hiding to nothing asking them not to cannulate you as all those require IV access... in theory I would expect A&E to be the most proficient at cannulation since they do it constantly. Practice makes perfect & all that. You become proficient at things like that with practice, take it from me, sticking something in a vein when you're 'new' at it, is not so great I pray that I will never need ABG's done just after the new junior doctors arrive LOL.
I'm currently in the process of learning to put my own cannulas in so that I don't have to go into hosp for IV fluids/hydro, as I get a lot of pukey things that would require it, and with the diabetes inspidus as well, the threshold for IV fluids is lower.
At the moment I'm just practicing getting access with a 23 gauge needle and syringe - I'm finding I can get in and get the 'flash' fine, but it's tricky to withdraw one handed without creating a bruise.
Once I've got better at the one-handed venipuncture we're going to move on to a 21 gauge cannula. My partner needs to learn as well in case I'm too shaky or confused to do it. I should stress that this is all with the approval of our GP!
I agree that increasingly hand-canulas have been super painful - I ended up with 3 in 2 hours recently on the ward because they kept suddenly infiltrating - I think they kept ending up with the end of the tube against a bifurcation, but I think it was also because they were pushing the HC without diluting it in saline and running it over a minimum of 10 minutes. Once they went over to bolus HC I found the vein damage stopped. I'd still rather go for arm veins though!
I got bad phlebitis last time I was in hops anyway, which I picked up and it still took them 10 hours to even get the infected line out due to not having a Dr on the ward - and them being panicked about leaving me without access. So GP and I have agreed that we're not increasing the risk by me learning to do it myself. (My endo initially suggested it as what he would do if he had Addisons!)
I wouldnt fancy trying that one handed, its fiddly enough doing my IV's one handed! Good luck with it, its a great idea.
in reply to
I wouldnt fancy trying that one handed, its fiddly enough doing my IV's one handed! Good luck with it, its a great idea.
Thanks NF - yes, it's pretty fiddly! Currently my left inner-arm looks a bit like I'm an extra from Trainspotting
I find I can get in, locate and puncture the vein at about 5 or 6 different sites, get the needle in a decent distance, withdraw enough blood into the syringe to be sure that I've not gone through-and-through, but I can't figure out how to get pressure on the site just above the puncture point *and* withdraw in a controlled way at the same time, so I'm getting the familiar blood-bubble under the skin as I withdraw. It might be that there's something I can do with tape briefly that would make it easier, and I'm told that the butterfly and handle on the actual cannula gives you a bit more control.
In most situations I'd be able to get my partner or a friend or neighbour to come and help I guess - so I could use them to apply pressure while I do the fiddly bits. It's even stuff like releasing the tourniquet at the right point - it needs releasing before the withdraw, which means letting go of the syringe/needle, which has had messy results at times!
My partner is quite good with her fine motor skills and her first jobs were as a nursing assistant so she's not squeamish, so I'm sure she'll be able to master it as well, but I don't want to be dependent on her being here as she goes out to work (as a psychotherapist).
My alternative option would be to use a vein that isn't on either arm, which I would definitely do if I was on my own and had no choice, but I know is a last resort.
If it keeps me out of A&E / MAU, where these days it seems around 80% of patients are COPD + infection, then that'd be great. Less infection risk and more sleep = faster recovery. That's the plan anyway!
Hi re adcal d3 I have just managed to get it in the dispersible solution which is a lemon f drink so much better than the chewable type
Sharon
Really? Does it taste better than the lemon chewable ones? I got them, I prefer them to tutti fruition, but still hate them quite a lot. It's a bit better since my GP said I can have both in the evening every other day, I hate eating anything first thing as my mouth feels all gross (ESP if my breathing a bad so my mouths really dry) and so it means I don't have to force it every day!
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I pray that I will never need ABG's done just after the new junior doctors arrive LOL.
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