Hi all, I am 71 ET to PV in 3 years now on HU 1000mg per day for 7 wks. WBC and platelets dropped dramatically, platelets from 620 to 170. Very little effect on RBC,s , Hct and Hgb. Hgb still at 49.8 Scheduled for first phlebotomy this week. I have poor veins and it almost always takes more than one or two attempts to draw blood with a 21 ga butterfly, probably the simplest draw of all.
I have been told that it can ONLY be done with a 16 ga pre packaged steel needle attached to a phlebotomy bag. They basically told me they will keep trying until they find a vein. I think I saw someone on this site who had the same problem and they mentioned they were done with a 18 ga angiocath which is a plastic catheter left in the vein after venipuncture. When I asked if they could do that they said no. I have no intention of becoming a pin cushion for the practice of the phlebotomist.
Anybody with small or difficult veins have any advice for someone in the same situation. I don't fear venipuncture, I know that large steel needles can be vein destroyers for future use. Any advice is appreciated. Best to you all.
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Meatloaf9
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I asked about the smaller needles and got the same answer. I am quite sure there are pediatric needles; however I would think that they would take longer and be more likely to clog up during the phlebotomy. I expect what really matters most is the skill of the phlebotomist. There really is a difference. This is one of the few times where I just do not have much choice in the provider. it is a bit of a pig-in-the-poke each time I go.
Hope you get a good phlebotomist. You can always ask for a another if the one you get does not seem up to the task.
I have been getting phlebotomies approximately every 8 weeks for almost ten years. The problem for the last few years is that the blood won’t flow very freely anymore. It’s as if the veins have rebelled! I agree there are greatly varying skills among phlebotomists. What I wanted to tell you is that the last two times the phlebotomist ( who had had past difficulties with me and who really isnt very good and knows it) arranged for an ultrasound tech to find and guide the needle. It has been awesome and eliminated the pin cushion effect! Good luck to you. Hope that can help you.
Thanks for the reply, it can't be very encouraging if they need an ultrasound to find the vein, I hope that somehow it becomes easier for you, all the best.
Hi Meatloaf9 I have the exact same issue. My veins are small, have kinks and bends in them, are fragile and scarred. The veins in my arms are so bad that now when I have a small blood draw, they take it from my hand - They used to have to get the vascular scan team in to scan for good veins, and still it didn't work. The interesting thing about that was that I could see my veins implode. Sometimes failure isn't due to the expertise of the phlebotomist, it's simply because we have bad veins.
I also asked about using smaller needles and was told no. They did try a cannula near my wrist which worked a number of times, but that stopped working when the vein became scarred - I was having to have venesection every six weeks at the time, so it can be done!
There was talk of inserting a catheter in my chest (PICC) which I wasn't too keen on as I stupidly 'Googled' it and read about a person with PV who suffered a blood clot, even after correct 'washing out' procedures were followed.
So now, I'm medicated with Hydroxy, and it thankfully works well for me. I tolerate it well, it controls my blood levels, and I haven't needed a venesection in two years.
I am happy for you that you haven't needed a phlebotomy lately, hope that continues for you forever. I am on HU for almost 2 months not but it has had little effect on the H and H. May I ask what dose of HU you are taking, I take 2 X 500 per day. Best to you going forward.
Thanks for the info. I spoke to my Doc yesterday and will have to make some changes to my 2 X 500 per day since my platelets have been dropping too fast. From 620 to about 170 thus far. Will be doing something similar to you. Good luck to you.
I sympathise. I had a regular phlebotomist who got so stressed when I arrived for venesection. She put a warm bad on arm before hand, gave me carton of apple juice to drink, I had to lie flat. And still it was variable. Then when having them at Guys they inserted drip in other arm and replaced the volume removed, so both in together, draining and topping up. I was always well hydrated. I sat upright and it worked. I think the replacement was because I couldn't function afterwards rather then to ease plebatomy. I did have one in New Zealand where I lay on coach, girl sat on floor, bag on floor and before she knew she had drained 500ml. My max was about 350. I mention this only because gravity obviously played a part. I joke that a job as a phlebotomist would be my very worst job choice. I think many of them are very nice people but not skilled in the fine tuning and sensitivity of inserting a big needle in a vein. At my local surgery I end up black and blue after blood test (with small needle) from one and no marks from the other. And final point. Wriggling the needle while in the vein causes me pain and distress so I beg them not to do it. It's such a steep learning curve so I am greatly relieved that Pegasys keeps me away from plebatomy, at least for now.
Sorry to hear of your past troubles. Glad that the pegasys is working for you now. I hope it continues, past 5 year studies show that it does is a significant % or patients. If the HU doesn't help I plan to request to switch to pegasys or besremi if I can afford it here in the US. Continued success for you.
I've always had a problem with giving blood, apparently I have inherited my fathers deep veins in my arms and tiny wriggly ones in my hands!
I always say it's usually taken from my hands but they often insist on trying my arms.
I had one phlebotomist who said he had never failed to get blood from an arm - he has now!
After having it taken at the GP's during the pandemic by different inexperienced "phlebotomists" and ending up like a pin cushion and covered in bruises I'm now back to having it taken at the hospital where they have a note what to use (childs butterfly) and where to use it (hands) and I usually see the same girl who gets it from my hand without problems or bruising.
My experience with phlebotomists who say they have never missed is that it is the kiss of death as far as finding a vein, or I am just bad luck for them and myself. Glad you have someone now who does a good job. Best going forward to you.
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