Venesection issues, looking for some advice, please.

[BlackOrangeCat]

I have a venesection next Tuesday, my 4th since a diagnosis of Molecular Negative PV in August 2023.

1 and 2 were fine, nurses were surprised at how quickly I was through (approx 30m - less that 1 hr). Beginning of March I was in the chair for about 1hr 40m, and nurse let me go. As it looked obvious I couldn’t do 500ml, nurse hoped for 400ml, but gave up at 360ml. I thought I’d drunk enough water to aid process. I’m currently “watch and wait” and daily aspirin. My haematocrit is currently only slightly above - 0.47, if memory serves correctly.

Looking for any tips anyone may have, please. Don’t want a repeat again if I can help it!

N.B. I’m small, so Consultant Haematologist says I shouldn't need a venesection too often. I’m given a “squeeze ball” each time.

[ainslie]

the simple solution may be to just have smaller venisections more often. I used to get 125ml because I couldn’t tolerate a full 450ml. Eg, you could do 200ml. Also important to hydrate days before but not excessively. We are more dehydrated overnight so either rise a few hours before venisection and drink half to one litre of water or venisect late morning or afternoon.

[BlackOrangeCat in reply to ainslie]

Thank you ainslie -good advice. It’s my day off, venesection is 3pm, so I’ll focus on my hydration.

[BlackOrangeCat in reply to ainslie]

It does make me laugh - I have too much blood and yet I’ve struggled to give it away!

[Transporter]

I have a similar issue as my veins aren’t great. I find that some nurses have a better success rate than others at getting blood out of me and try to see the same one each time.

I do try to make sure that I have had plenty to drink before I go for a venesection and also that I am warm if it is a cold day.

[BlackOrangeCat in reply to Transporter]

Yes, my veins aren’t great, either. And, as you say, it does depend on the skill of the nurse. Years ago, way before PV, very bad experience with a practice nurse. Yes, I’ll drink plenty and wrap up well, as I do feel hot and cold much more since my diagnosis.

[Imkerin]

Hi there, yes, agree with everything said about the importance of hydration. I too have had very different experiences of venesections including one occasion when as the nurse struggled to get the blood flowing chided me for having 'thick blood'. As the later test results showed from the sample taken immediately before the venesection, my HCT was .43 - so not thick at all. Why I was having a venesection with a low HCT is another story. I've also been chided for having 'difficult' veins, not being hydrated, of having too many valves in the vein. The skill and also 'the art' of inserting a cannula varies enormously from clinician to clinician and is not related to the level of qualification. When I started on this MPN journey, venesections at the specialist MPN clinic could take up to three hours to complete. After a transfer to a local hospital I was astounded and very relieved to learn that it could be a far less painful and lengthy procedure, in the right hands, in this case a nursing assistant. One tip I have picked up along the way is that once the cannula is properly in place, rather than use a squeeze ball (or as well as), get into a rhythm of clenching and releasing your buttucks! The first time I tried this the blood flowed so quickly I nearly feinted.

[BlackOrangeCat in reply to Imkerin]

Clenching buttocks! Thank you! I’ll definitely try that! Yes, my haematocrit has been 0.47 last 2 times, so only slightly elevated. And yes, it does depend on the skill of staff. No bruising after blood test last week, but massive bruising after my last venesection, the one that prompted this post.

[KLCTJC]

Try to get it done in the afternoon and drink a ton of water. Been a while since I have done one but I don’t think I ever had one in the morning. I usually ate something and had already drank like 64 oz of water, but I am lucky my blood has always flown fast! One time I was in the back and it started going so fast and I couldn’t really move. Tried to yell but next thing I know I passed out! That day the took 1000ml at one time, needless to say I felt horrible. But I have done a 250ml before because seems after that incident phlebotomies make me feel bad. And I have had more than one in one week when I first go diagnosed, you could do that in smaller amounts. Just sucks to get stuck with that 18 gage or 16 gage needle!

[BlackOrangeCat in reply to KLCTJC]

Yep, mine is at 3pm. Always a Tuesday (my day off), I have gym in the morning, so leave a recovery gap. I’ll drink plenty and eat beforehand to help my blood sugar levels. I always take a 24oz water bottle, chocolate, and drink a bottle from the staff, too. Smaller amounts and so more venesections sounds like a good idea, if my problem persists, I’ll ask about that. Bigger needle (shudders!) OK, sounds like an option. Had a lot of needle as a kid (small, sickly), but now getting much better with them where I was not so great.

[william-Indo]

For the next phlebotomy, ask nurse to give you Sodium Chloride IV, while perform venesection.

If still not working, ask warm bag to place at your arm to support blood flow.

Use biggest needle is advantage.

Best place to do phlebotomy is RED CROSS clinic ( cost cheap and very fast)

Cheers

[BlackOrangeCat in reply to william-Indo]

Good idea to keep my arm warm, so I’ll do that. And I’ll find out more about Sodium Chloride IV to see if that’s suitable, how it might benefit me, if I choose to take it.

[BlackOrangeCat]

Thank you to everyone for replies so far. Some useful information. And thank you for sharing your experiences, I appreciate it.

[Bobadog]

Hi,

Yes I now always have a saline IV (250mls)at the same time as venesection too.

Also the success of the procedure is very ‘clinician-dependent’.

Some are excellent, and really have the knack,and not always the senior nurses .

Try and remember the name of your clinician , after a successful venesection, ,and request the same person….no harm in asking,

All the very best,

Bobbie

[BlackOrangeCat in reply to Bobadog]

Thank you! I think I was just unlucky last time, sure I’d had that clinician before. New to me clinician one today. No problems this time, glad to say. Done in under 30 minutes. All clinicians have been marvellous with me as I say I’m not great with needles. I like to let them know beforehand, even though I always end up not having a problem. Stems from childhood, lot of blood tests, a small, “delicate” child who grew to be a 4ft6” adult. Each clinician has sat with me and we’ve talked throughout each one, four as of today. Wonderful reassurance.

[Innessant]

Take a baby aspirin as well as the extra water. I have been doing it for 10 years now. Blood letting may not be enjoyable but it is better than the alternative.

[BlackOrangeCat in reply to Innessant]

Thank you, am on daily aspirin, and I’m small (4ft 6”), so the 75mg may be enough, but I’ll bear it in mind. My Consultant Haematologist said I shouldn’t need a venesection too often as I’m small.

[BlackOrangeCat]

***UPDATE*** Just had my venesection.

Only complication is low blood pressure, so I’m now eating some chocolate biscuits as I type this.

I was done in under 30 minutes this time! I hoped I’d drunk enough, and looks like I had. Thank you to all who offered advice.