Problem in getting vein during transfusion-pls help

Dear all, I m Rima - a new member. Mother of a 3 yr old thal major daughter.
By reading the posts, i have already received lot of guidance and mental support to handle this situation.
Need yr advise for below: during the last BT for my daughter last saturday, 1) the first problem faced by the nurse was locating the vein. She said ki now veins are easily accessible but seems blocks. She gets correct open vein only after 3-4 pricks. And i feel so depressed to see my daughter crying for so long. Is it normal for thal major on regular transfusion? 2) The second problem appeared when the nurse came to take the sample again saying - the earlier one had clot. what is this? 3) And the third problem came when during the transfusion, her hand started swelling and the nurse immediately removed everything and after some time pricked again on other hand.

This has not happened before...I feel so miserable. Pls help.

Hi Rima,
You are Welcome and you are at right place for getting help.
1. Whether the same nurse took the veins at a place where u r going for Blood Transfusions. As generally at Thalassemia Ward the experienced staff perform the duty and mostly they took the veins in first time or at second time. It is looking like that the staff is not experienced person. Sometimes it happens and it's normal but can be avoided by expert nurse at children hospitals.
2.The earlier one vein has clot means? Do you use Butterfly needle or Vasofix(Vigo/Mediflon). When using Vasofix whenever it is in place it must be pushed with Distilled Water or Saline to avoid clots then it should be capped.
3.It seems that you are using Butterfly(TOP Scalp Vein set) needle for your daughter and it become out when your daughter move her hand.

So, if you are using Butterfly needle ensure that the hand is not moved by your daughter.
If it Vasofix then push distilled water every time before closing the cap.

You can ask if u have any doubt.
Dharmesh

Dear all, I m Rima - a new member. Mother of a 3 yr old thal major daughter.
By reading the posts, i have already received lot of guidance and mental support to handle this situation.
Need yr advise for below: during the last BT for my daughter last saturday, 1) the first problem faced by the nurse was locating the vein. She said ki now veins are easily accessible but seems blocks. She gets correct open vein only after 3-4 pricks. And i feel so depressed to see my daughter crying for so long. Is it normal for thal major on regular transfusion? 2) The second problem appeared when the nurse came to take the sample again saying - the earlier one had clot. what is this? 3) And the third problem came when during the transfusion, her hand started swelling and the nurse immediately removed everything and after some time pricked again on other hand.

This has not happened before...I feel so miserable. Pls help.

Hello Rima, hope you and your daughter are now doing well.

1. When I was small, a doctor at which I went also has to make 4-5 pricks to take my vein or transfuse and that was also too disturbing for my parents to see as well. My parents told me as I grew elder that when I was small and was taken to transfusion, I would recognize that doctor's road around 500m earlier and start crying from there only, haha, well, fun apart. May I ask which state of India do you belong to or are you staying in India? Well, after these all hassles and multiple pricking, my parents changed doctors and since that time till today's date, I have the same 4-5 family doctors now and they hardly have any bad day that I am supposed to prick two times. So I can advice that you also consider or survey some other clinic and try that and see if they are good at taking veins.

2. A clot is a situation where the blood, or plasma (watery substance), we can say is jammed temporarily due to which the blood cannot flow which can be solved easily by pushing some distilled water through the injection through the pipes of the butterfly or vein-flown.

3. The swelling, often occurs when the butterfly or vein-flown wasn't properly injected into the vein, causing the needle to touch the bony part of the hand due to which it pains the hand and often ends up swelling that part. It is often said as "the vein is out".

Regards,

-P.

Dear Rima,

I completely understand your frustration.  My son is almost 14 now and transfusions have become much easier. 

We had challenges when he was younger as well, their veins are small in the hand and they often have many valves - the nurse will be able to insert the needle but not be able to flush through because the end of the needle has hit a valve.   My son required multiple pokes to start a transfusion as well.  Things are much better now. 

What you can do to make it easier for your daughter is:
1) ensure that the pretransfusion hemoglobin is above 9.5

2) give your daughter plenty of fluids the day and the night before her transfusion

3) ensure that she is very warm - perhaps put an extra layer on her before her transfusion as this will plump up her veins. 

4) getting her to be active and have her moving around will also get her blood pumping and the poke will be easier. 

I hope that all of this helps.  Most important, we need to remain calm during the pokes.  We need to act like it is not a big deal and your child over time will learn to think of it in the same way.  It is the toughest thing a parent has to do, but you have to be very matter of fact about it.   As a parent, I have watched my child get IVs for 14 years and I also inserted needles in his stomach from the time he was 18 months old until he was 11 years old.  I understand how you feel, and these are the techniques that have worked for our family.

I wish you and your family all the best,

  Sharmin

Thanks to all for your guidance
my daughter is also very young. she is only 2.5 years old. sometimes nurses prick her 3-4 times and couldn't find veins.It is really very frustrating for all parents. being a parent we all are helpless. it have to done
but these information will help us a lot.........

Thank you dhrmesh/pratik and sharmin for your reverts.

The problem with vein out  just happened during the last transfusion and the vein location problem is since last 2 BTs. The nurses are the same since my daughter was 4 months old and now she is 3 yrs old. Only recently she is needed to prick at least 3-4 times to get correct vein.  otherwise  in the 1st prick all was well. do u advise any cream or massage before BT?  her pre HB remains between 8.5 - 9 and sometimes 9.5 at 4 weeks interval.

Have read about wheat grass. pls guide me about that. Does it help in maintaining HB?

Thanks Sharmin for your encouraging words...It really helps.

Rima

Thank you dhrmesh/pratik and sharmin for your reverts.

The problem with vein out  just happened during the last transfusion and the vein location problem is since last 2 BTs. The nurses are the same since my daughter was 4 months old and now she is 3 yrs old. Only recently she is needed to prick at least 3-4 times to get correct vein.  otherwise  in the 1st prick all was well. do u advise any cream or massage before BT?  her pre HB remains between 8.5 - 9 and sometimes 9.5 at 4 weeks interval.

Have read about wheat grass. pls guide me about that. Does it help in maintaining HB?

Thanks Sharmin for your encouraging words...It really helps.

Rima

Hi Rima,

What I do just before transfusion is wash my hands in hot water for a minute or so, so the veins get warmed up, fresh and active and as well as soft, so it might give some aid in getting the vein. Also try to keep her active and busy, that'll make the blood flow nicer throughout the body.

And about wheat grass, I too tried it when I was small. I didn't took most of the times as the taste made me say yuck! It might help a bit, but don't expect any wonders to happen. Either way, there's no side effect or bad thing taking or consuming it, so if your daughter feels okay with it, you may continue it.

-P.

We find the more hydrated our son is on transfusion day and leading up to transfusion day, the better for the needle to go in for the IV line to start. We push liquids orally for him 48-72 hours before transfusion and lots to drink that morning.
Also, to relax during the line start (prick). He learned at age 3. To keep arm relaxed. To blow out like he is blowing out candles. If he tenses up, it is hard to find a vein.
Also, make sure person starting the line is experienced with finding veins for young children.
Nicole