Problem in finding veins

Dear All
My 6 .5 yrs old child is having one problem. Thne nurses are not able to find his veins for transfusion. At times they prick him 6-7 times and he is under severe pain. We, as parents, feel very down psychologically and feel helpless. Nurses were saying  that most of the Ani's  veins has developed Thrombos and the needle does  not go inside and there fore they have to prick him in multiple places.
is it a common problem ? Is there any medcicine to remove these gland type thrombos-what they say. How to at least make the need;le pricking proper?
Also in last transfusion we have tried scalvel-set( Butter fly type needle) . Earlier they were usin Intra c-cat( Plastic pipe Type arrangement? Also since ;ast4-5 months . they give Haparin after the transfusion. They said that it will not allow Blood to cloat. is it right ?
What othe child do ? Can some one guide us please
Rgds
Anis father

Dear Ani's father,

It is very common for nurses to have difficulty finding children's veins.  It has happened to our son many times.  We find that having him drink plenty of fluids the day before and morning of the transfusion helps.  Also, putting an extra layer of clothing on so that he is warm before the transfusion helps as well. 

I don't know why they are using heparin - I have never heard of that before...Perhaps someone else may know..

Sharmin

Hi Ani,

We had similar discussion a while ago, where member posted their valuable tips which was really found to be helpful. I advise you to see both of the below topics:

http://www.thalassemiapatientsandfriends.com/index.php/topic,4574.0.html
http://www.thalassemiapatientsandfriends.com/index.php/topic,4651.0.html

-P.

One more thing that can help is taking low dose vitamin C daily, as this will improve the quality and strength of the blood vessels. Thals should not take high doses of vitamin C, but for a child of this age, 100 mg daily is suggested.

We hydrate our 5 year old with more liquids starting 72 hours prior to transfusion day.
When we arrive at the hospital, they apply hot packs to his arms.

Some people have luck with EMLA (numbing cream) but with our son they cause his skin to dehydrate and his blood vessels to retract.

If it's a hard line start, an IV nurse sometimes will inject Lidocaine. This will sting for a moment but then numbs the area and the nurse can DIG w/o him having pain.

Sometimes a different nurse has better luck than the first one who has not been successful on that day.
Some places have "vein finders" (some sort of machines - we have never used one, but our ER does have one. I know Boston Hospital Children's has one).
Nicole

Thanks all of you for your valuable suggestion. I think water intake very important before transfusion. Shall try to do that and also shall try to cover his arm to keep it warm.My Sons spleen is also very big. Is it normnal for all thal patient or is it not. Inspite of trying our best and transfusing him 2 bags( 180 ml x 2) every 21 days , we find the HB between 7.8 to 8 .  Hia body wt is 24 Kg and age is 6.5 Yrs. Pl suggest .

Thanks all of you for your valuable suggestion. I think water intake very important before transfusion. Shall try to do that and also shall try to cover his arm to keep it warm.My Sons spleen is also very big. Is it normnal for all thal patient or is it not. Inspite of trying our best and transfusing him 2 bags( 180 ml x 2) every 21 days , we find the HB between 7.8 to 8 .  Hia body wt is 24 Kg and age is 6.5 Yrs. Pl suggest .

Ani,

7.8-8 is a little low. Hence the spleen size. You should aim for 9 or above 9, not only to keep spleen size in control but also to keep his growth good and keep other functions good. While doing that, also adjust the chelation dose as per it so that he throws good sum of iron out.

I too transfuse every 21 days with around 450-500 ml/cc of blood and maintain my Hb above 9 almost all the times, sometimes even around 9.5 or above.

360 is a little low (180 X 2). Try to transfuse him around 450 or so, so his Hb would be around 9 or above, before transfusion.

-P.

ANi,

Our daughter drinks a big glass of milk in the morning and then have her sip into a bottle of water on the way to the hospital. we generally do the blood draw early morning...when she was young,  we used to wrap the area with a mitten to keep the hand warm. ALso, the nurses always used a hotpad for few seconds before poking. Also try to keep your child calm during the poking. I have seen when our daughter is very agitated, not all nurses can keep calm and do a good job the first time.

regarding the amount of blood, i think your child is gettign less ...generally the rule of thumb is below 9.9 Pre Tx Hgb, the child shoudl get 20/kg (i think it is cc not exatly sure)./ between 9.9 and 10.5, it shoudl be 15cc/Kg. if the child is always coming at 8, you should try the 20cc/Kg first before reducing the Tx frequency lower.
we have never used Heparin so I can't comment on that.