Mr. Lodwick Question

[Ross]

Al do you have a reference or can you point me to guidelines for testing A-PPT and Heprin drips? Lord almighty, those people were sticking my veins every 6 hours for blood and adjusting the drip with every poke too. Why do lab techs try to use large bore needles in tiny veins? I wanted to reach across the table and slap one girl. Sticking me with a 21 gauge needle in a hand vein just slightly larger then the needle and couldn't understand why it collapsed. I asked her to use a butterfly or something more like a 30 gauge needle, but she said, "I don't like them" You know what? I don't care what she likes, it ain't her vein she's sticking with the damn thing.

 

[Guest]

A hospital should have its protocol. You were probably being stuck more often because you had ac active (or recent) bleed. This is probably an exception from the protocol.

 

[Ross]

Just wondering if you knew what the true protocol would be.

 

[RandyL]

They drew my blood every 6 hours until I asked for a PIK and got one, then only the nurse could get blood which was every 8 hours and it didn't hurt anyways.If I ever go back in I will demand a PIK or 2 ,it makes life so much easier.

 

[Mary]

A hospital should have its protocol. You were probably being stuck more often because you had ac active (or recent) bleed. This is probably an exception from the protocol.

When I was hospitalized after my TIA, my blood was drawn four times a day. I hated it.

 

[Ross]

They drew my blood every 6 hours until I asked for a PIK and got one, then only the nurse could get blood which was every 8 hours and it didn't hurt anyways.If I ever go back in I will demand a PIK or 2 ,it makes life so much easier.

I asked for a PICC line and it went ignored. They tried to tell me that they couldn't use it for drawing the test specimen. B.S., they did it before with my other PICC line. The Heprin lock isn't going to throw the test off that darn much.

 

[Marty]

? PICC line

? PICC line

Very useful for cancer chemo. In my experience not often used for drawing blood.
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What is a PICC line?
For some years now doctors have been using central lines for some people who are going to have chemotherapy that would normally require a lot of injections and blood tests.

A central line is a thin flexible silicone tube, the tip of which is placed in one of the large veins deep in the chest (the superior vena cava). The line is put in under either a local or a general anaesthetic. The outside end of the line is on the chest, just above one or other nipple. It then tracks under the skin for a little way before going into a large vein just behind the collar bone. From there it goes into the superior vena cav

A PICC line is a more recent development using a line which is inserted into one of the large veins in the arm (usually near the bend of the elbow) from where it is threaded into the superior vena cavThe initials PICC stand for peripherally inserted central catheter.

PICC lines are normally inserted as an outpatient. Some local anaesthetic cream is applied to the skin which usually ensures the insertion is painless. The procedure takes about 30 to 40 minutes. Once the PICC line is in place it will be taped firmly to the skin with a special transparent dressing to stop it coming out of the vein. A chest x-ray will then be taken to check the position of the line before it is used.

The PICC line can be used for taking blood for blood tests, giving chemotherapy drugs or giving blood transfusions.

Once the line is in place nurses will show you how to take care of it, to prevent any blockages or infections. This will involve learning how to clean the external part of the line, change the dressings and flush the line through with sterile salt solution. This may sound complicated at first but the nurses will explain it all and make sure you are able to cope. They will also give you a contact 'phone number at the hospital in case you have any problems.



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[Ross]

If anyone else should need it, Heparin Assay Monitoring For Heparin Continuous IV Therapy. I found one from Ohio State University:

http://www.ohsu.edu/medicine/reside...gToHeaprinAssay.pdf#search="heparin protocol"

 

[Guest]

The protocol runs about 5 pages with all of the exceptions.

 

[DrAllan]

The use of a PIC line is very helpful. However, there are risks associated with this that are far greater than that of a normal venipuncture every 4-6 hours to determine the rate of the heparin drip. Basically there is another foreign body in the blood stream and more important a continual defect in the skin with access to the subcutaneous tissue and the vein into which it is inserted. In spite of careful attention to cleaning the area and protecting it with sterile transparent adherent dressings, infections do occur. I cannot quote the risk of septicemia or local infection from the devices. The literature on PIC lines strongly suggest a low incidence of septicemia compared to other long term line insertions, but do no compare to repeated venipunctures, for which I have not been able to find any statistics.

 

[Ross]

The use of a PIC line is very helpful. However, there are risks associated with this that are far greater than that of a normal venipuncture every 4-6 hours to determine the rate of the heparin drip. Basically there is another foreign body in the blood stream and more important a continual defect in the skin with access to the subcutaneous tissue and the vein into which it is inserted. In spite of careful attention to cleaning the area and protecting it with sterile transparent adherent dressings, infections do occur. I cannot quote the risk of septicemia or local infection from the devices. The literature on PIC lines strongly suggest a low incidence of septicemia compared to other long term line insertions, but do no compare to repeated venipunctures, for which I have not been able to find any statistics.

Your right of course. I gave that lot of thought before asking, but fact of the matter is, my veins have been poked so many times over the years that most simply collapse the minute I get stuck. I'm tired of multiple sticks for one darn test. For me, the risk is acceptable now a days.

 

[Marty]

The use of a PIC line is very helpful. However, there are risks associated with this that are far greater than that of a normal venipuncture every 4-6 hours to determine the rate of the heparin drip. Basically there is another foreign body in the blood stream and more important a continual defect in the skin with access to the subcutaneous tissue and the vein into which it is inserted. In spite of careful attention to cleaning the area and protecting it with sterile transparent adherent dressings, infections do occur. I cannot quote the risk of septicemia or local infection from the devices. The literature on PIC lines strongly suggest a low incidence of septicemia compared to other long term line insertions, but do no compare to repeated venipunctures, for which I have not been able to find any statistics.

My point exactly. I would not want a PICC along with my mechanical valve if I could avoid it.

 

[LUVMyBirman]

They tried to send me from CICU up to cardiac stepdown with the PICC line in me! Why, guess it's because I am a hard stick. I demanded they remove it. Did I mention it was in my neck!! What is it with heart patients and tiny veins

Ross, hope you are feeling much better my friend. I would guess you were stuck over and over because of your bleed. This was my experience. Something like 6 times a day! They were ready to go for my heals. Luckily I was dischared before they had the opportunity.

 

[Ross]

My point exactly. I would not want a PICC along with my mechanical valve if I could avoid it.

The key thing is, if you could avoid it. I have no veins left to speak of to stick. Like LUVMyBirman, the only alternative now is the ankles and I'm not going there.

 

[ALCapshaw2]

SO, how painful is it to stick a vein near the ankles or heels, using a fine needle or butterfly?

...or is this one of those "If you have to ask, you DON'T want to know" type questions?

'Al Capshaw'

 

[Nan]

Hi Ross, I have a similar problem, very small battered veins that blow at the slightest attempt to draw blood. It's awful, I am so sorry you had to go through that.

Just FYI....I begged and pleased for a hep lock (when in the hospital for flash pulmonary edema) so they could draw blood without constant sticks...they had done this when I was in the ICU. The hospital nursing staff finally aquiesced. However, the next day when my cardio came in he was literally yelling at the staff to get that out of my arm NOW!! He then told me that he was concerned about possible infection.....I don't believe this was even a PICC line, just another IV set up with a HEP lock.

So, I guess there is some concern about infection. I am with you, I would rather risk it when they are sticking you multiple times a day. I have on occasion refused when I just couldn't take it any more. You can imagine how popular I am in a hospital setting. But if it is just protocol, and things are in control...I don't see any reason for this torture. If they can give me a concrete reason, that is a different matter.

Glad to see you posting again, but hope you are resting and not doing too much.

 

[Ross]

SO, how painful is it to stick a vein near the ankles or heels, using a fine needle or butterfly?

...or is this one of those "If you have to ask, you DON'T want to know" type questions?

'Al Capshaw'

Al if the damn lab techs would listen and use those requested needles, I wouldn't be even be asking this. Fact of the matter is, I asked repeatedly for small gauge needles to be used and out of the 24 tests I had, only two of the phlebotomists actually listened to me. The others were harpooning me with 21 gauge needles in very tiny veins and couldn't figure out why they blew in an instant, requiring yet another stick somewhere else. My entire left arm is black and blue from all of this crap.

 

[Ross]

Hi Ross, I have a similar problem, very small battered veins that blow at the slightest attempt to draw blood. It's awful, I am so sorry you had to go through that.

Just FYI....I begged and pleased for a hep lock (when in the hospital for flash pulmonary edema) so they could draw blood without constant sticks...they had done this when I was in the ICU. The hospital nursing staff finally aquiesced. However, the next day when my cardio came in he was literally yelling at the staff to get that out of my arm NOW!! He then told me that he was concerned about possible infection.....I don't believe this was even a PICC line, just another IV set up with a HEP lock.

So, I guess there is some concern about infection. I am with you, I would rather risk it when they are sticking you multiple times a day. I have on occasion refused when I just couldn't take it any more. You can imagine how popular I am in a hospital setting. But if it is just protocol, and things are in control...I don't see any reason for this torture. If they can give me a concrete reason, that is a different matter.

Glad to see you posting again, but hope you are resting and not doing too much.

Give me the PICC line and if you must, Vancomycin in case of infection. I had it once already for 6 weeks at home and I realize there is the risk of infection, but after all I've been through with all my surgeries, I'll accept that risk.

 

[Gnusgal]

Give me the PICC line and if you must, Vancomycin in case of infection. I had it once already for 6 weeks at home and I realize there is the risk of infection, but after all I've been through with all my surgeries, I'll accept that risk.

I had one when I got my infection at the defibrillator site a year and a half ago. I had to have IV antibiotics for six weeks, so they gave me the PICC and sent me home with the antibiotics. And I FULLY appreciate it. I loved that little thing. Once it was in I didn't have to be poked over and over again. Granted, I wasn't overly fond of the process of putting it in, but at least it was over and done and I could enjoy its rewards...

When I had mine put in they gave me adivan to "calm" me for the process. The adivan did not effect me one bit until after the whole process was over. At that point, I started having hallucinations of the wall moving, the patturn in the wall paper turning into various things, etc. and ultimately I threw up twice. But even with all that, I would take a PICC line over vein abuse any time!

 

[Guest]

You should not get vancomycin unless it is absolutely necessary. If you get a vanco resistant infection - you can pretty much put yo' head between yo' legs and kiss yo' tail good-bye.