That infiltrated feeling isn't a good one

Infiltrate

in-fil-treyt, in-fil-treyt

verb (used with object), in·fil·trat·ed, in·fil·trat·ing.
to filter into or through; permeate.
to cause to pass in by filtering.
to move into (an organization, country, territory, or the like) surreptitiously and gradually, especially with hostile intent.

In nursing, it has a specific meaning.

Infiltration occurs when I.V. fluid or medications leak into the surrounding tissue. Infiltration can be caused by improper placement or dislodgment of the catheter. Patient movement can cause the catheter to slip out or through the blood vessel lumen.

I present these definitions because on Wednesday at ECP, the light therapy on my blood, the needle in my right hand infiltrated. This has happened before. It is not the end of the world. But when it happens, it is painful. I usually know it the minute the needle goes in. It doesn't feel right.

Surveying the damage

Nancy, my nurse, put the large needle in my left arm, for the draw. (Drawing out my blood so that the white blood cells can be separated and treated with UVA light.) Rosalie, a nurse who had a different patient, came over to help with the return needle, the smaller one. She patted my arm and my hand vigorously to get a good vein. Actually it felt kind of like slapping. She put the needle in and went back to her patient.

I told my nurse that it hurt. She took one look and said it was infiltrated. She pulled it out. There was some extra blood. She had to bandage it up before she put the needle in a different spot. My right arm was unhappy.

Meanwhile, my left arm wasn't doing so great either. My hand had a bad case of pins and needles. You can't move your arm, so you can't shake it out. The needle in the crook of my created a dull ache.

For a while I was taking a little oxycodone before, because I had had a few bad instances of severe pain when the needle felt like it hit a nerve. I haven't even been bringing it for a while. But with both arms hurting, I said maybe I would in the future. (Tylenol doesn't do it. I can get oxycodone at ECP, but it's a major production, and Melissa had said to bring my own.)

A nice resident, new on the rotation, came over to talk. I gave him a brief history of my two-plus years at ECP, going back to when I asked my doctor why my abdomen felt like it had a bowling ball in it, and why there were ripples in my thighs, and he said it was graft vs. host disease of the skin.

He thanked me for the info. I should get a teaching fee! Then I fell asleep. When I woke up, it was almost time to leave. I wasn't sure how I slept through being that uncomfortable, but maybe it was a defense mechanism or something.

When the needle hits a nerve

Yesterday started out on a good note with the tennis round robin but did not end up so well.

The ride in to Boston for photopheresis was fine. I had the Turkish owner of Sonic Velocity who dispatched loudly from his phone and watched the monitor in his car but I didn't care because he is polite (unlike Kenny) and efficient and gets me there on time.

It was downhill from there.

The needle started hurting almost from the beginning. I asked for a heat pad, which usually helps, but it didn't. I gave it a little time but at about the fourth cycle of pulling my blood out (there are six) I asked Ellen, the PA, if I could have an xycodone. She doesn't like to give it to me. I have been through this with her before and ended up in tears because I only ask for it when the pain is intense.  I try to explain that Melissa and Dr. Alyea prefer it for me, of course when used judiciously, as opposed to Tylenol (bad for my liver) and ibuprofin. I'm not sure exactly why they don't want me to take Advil and such but I just know that they don't.

Sometimes it doesn't hurt at all and I breeze right through it, watch a movie, talk to the nurses, read the paper, or fall asleep. Yesterday was not one of those good days.

Ellen said she would give me two extra strength Tylenol and come back in 20 minutes. In that period of time it started to hurt more. I said I needed something stronger and by this point I was writhing in pain and crying and thinking I might throw up. She said that there wasn't much time left (actually there was at least 45 minutes of hell) so it wouldn't make sense to give me the oxycodone because it wouldn't take effect until it was over.

 She agreed to give me some Ativan under my tongue to calm me down. Rosalie held my arm higher. It took the pressure off somewhat. They said it must have hit a nerve. I was never so relieved to have that needle out.

I fell asleep in the car and could barely keep my head up at home because they had given me a whole milligram of Ativan. This morning when I woke up and wrote Melissa I was crying.

Ellen is going to talk to her about going every three weeks instead of two because my veins might be getting tired. I said to please talk to Ellen and explain that I know what I'm doing when I ask for the stronger medicine. One of the nurses said to just bring my own and pop it without asking but another said that is going against protocol. I don't like to take it for no reason but I might just take it before the procedure next time to avoid the pain and suffering of yesterday.

Melissa said she was fine with either talking to Ellen or having me take my own prescription beforehand or during. I'm leaning towards just taking it before so I don't have to worry about it.