theantichick

Some people's veins are truly harder than others. You may have something going on that makes you truly a hard stick. I've run across a couple of people in my career as a Paramedic and ER nurse who I just COULD NOT trap their vein. I'd have to feel your arm to be able to judge. It also ticks me off, because there are nurses and techs that are just flat out bad at the skill, but instead of learning how to get better, they tell the patient that it's [fill in the blank] of the patient that's causing the problem. So there's lots of patients out there who are NOT hard sticks who think they are. When they go in, they tell the nurse "I'm a hard stick" and it actually sets the nurse up with the expectation that they're hard and like many other delicate skills, confidence is everything. So it becomes a self-fulfilling prophecy, and it harms patients. Anything that harms my patients, frankly ticks me off. Try not telling them next time. Don't say anything other than if you have a place you don't like being stuck like your hand. If they specifically ask, shrug and say "I'm about average, probably." See if it changes the dynamics. And if you truly are a hard stick, you can request that they use a vein finder or a sono site right off the bat. Sono sites are only for IV's, so it won't help with blood draws. If they only have one nurse trained for sono site (for us it was the shift supervisors who were trained), it may increase your wait significantly, and in an urgent situation you may not be able to wait. Cheap-o vein finders are about $30 on Amazon. If I was a particularly hard stick, I'd bring my own. If you have a chronic condition where you have to get blood draws all the time, find out who's the best tech they have and specifically request him/her. We had frequent flyers at the ERs where I worked who had 2 or 3 preferred nurses or techs who had a history of good results, and they'd ask for them by name. If we could, we'd try to accommodate.

My poor hubby. My kiddo has bipolar and wanted to try to go off her meds for the summer, so she's been tetchy, and I'm apparently about to get mondo PMS-y. He may want to strike a tent in the backyard or move into the garage.

Yes, our radiographers are usually only placing needles into the AC - and most of them need to see the vein to place the needle. Most of them also fear the hand and the bigger needles that are needed for higher flows and would never use the forearm. I always shake my head when they get one of the radiologists because the patient said "I'm getting chemotherapy", I get there and I see veins in which you could throw a needle into while still standing at the door of the room. They assume that all patients getting chemotherapy automatically have bad veins without even looking. Ugh. Yeah, I understand that you need a big pipe for dye because of the pressure injector. Interestingly enough, I had a chance to chat with a rad tech one night in the ER and he said that his preference is actually high on the forearm, because the AC's are positional enough that sometimes a slight bend in the arm will cause the pressure injector to blow it, or push it off the hub which makes a HUGE mess. I started going down onto the forearm if I could find a vein that would take an 18ga or 20ga (our rads said min 20ga) and having fewer restarts on the CT table. Heck, I've had patients that I could put a 16ga in their hand.... not that I'd do that to anyone unless they'd bit me or peed on me already. Ah, good times, good times. LOL.

I refuse lidocaine for IV starts. My experience is that it makes the veins more liable to blow. I don't think it hurts bad enough to mess with it. I had an anesthesiologist ask one time "what, do you LIKE pain??". LOL.

I haven't had a knee replacement, but had autologous cartilage implantation with a tibial tuberosity transfer (Fulkerson's) which was an open knee operation with 18 months total rehab (4 months at PT, 14 months on my own at the gym). Here's my advice, FWIW. Use the CPM machine religiously. It can be a PITA, but it's worth it in the long run. Learn to love those sadists at PT, and do what they say even if it hurts. Get someone to write a script for an IceMan (http://www.djoglobal.com/products/donjoy/donjoy-iceman-classic) and pay for it out of pocket if you have to - price match online, there are a few discount suppliers where it's reasonable. Get in the pool as soon as they clear you for submersion. Nothing helped my ROM more than getting in the Water and either deep water jogging or just water walking (I wasn't clear for the kicking needed for actual swimming to start, but just moving in the water was easier and gave resistance to help push the ROM.) I don't know if you'll have issues as long as I did, but a riser on the toilet and a shower bench were lifesavers. I don't work bedside anymore, because I have auto-immune arthritis, but if you have the option try to go back on shorter shifts. 12 hours on a post-op knee is sheer hell for quite a while.

So I'm already incredibly lucky that my doc doesn't do a full liquid or even low carb pre-op diet. I'm supposed to have 2-3 shakes a day, plus a "healthy dinner" and can have "healthy snacks" if I just have to eat something. She said there's no specific calorie or carb limit. I'm trying to even figure out what she's trying to accomplish. (I know, I should have asked... hindsight and all that) I'm on day 3 of 14. Day 1 was rough. I had a Protein bar instead of one of my shakes, and my dinner wasn't as healthy as I'm sure she meant, but I thought that wasn't too bad. Day 2 was better. Doesn't help that I have to be off my meds for psoriatic arthrtitis, so I'm hurting pretty badly and can't do crafts or the things that would distract me. Have been doing OK today, less headachey and less hungry. BUT. We have to drive 45 minutes directly after work to pick up my step-daughter. We always get caught in heavy traffic, and usually stop for dinner in order to miss some of the traffic and feed the starving kiddo (she's got a high metabolism and is ALWAYS hungry). He mentioned something about Taco Bueno (SD's favorite restaurant in the world) when he dropped me off at work this morning. I told him I can't possibly find something healthy at Bueno. He said we'd figure something out. Kiddo's pretty picky, and will be starving when we pick her up. I'm going to be starving and in a crappier mood than I am now. If we then have to drive an hour home (or more) in traffic without eating, it's going to get ugly. Mind you, hubby has been awesome. He doesn't want to do the liquid diet with me (and who can blame him) but he's working to keep crap food out of the house and fix healthy foods, and is doing tons to support me. This isn't a gripe fest about hubby. If I say we can't stop, we won't stop. Or if I say that I can only eat out if we go to X restaurant, he'll go along with it. So. I'm trying to figure out the best way to handle this. Find a restaurant that has better fare like Applebee's and then just exercise superhuman strength to not order what I am craving? Pop a Protein Bar in my purse (I keep a stash at work) and eat it at the restaurant while they have food I can't have? Say "screw it" and enjoy? I know that I'm far enough out from surgery that this realistically just isn't going to make that much of a difference. But it makes me feel like a complete failure if I can't keep on a diet even for just 2 weeks. Like maybe I'm not nearly as prepared for this as I think I am. I said from the beginning that it was the pre-op diet that had me more worried than any other part. I don't want to just say "screw it". I also don't want to rationalize my way into eating something and claiming it's allowed just because the doc's instructions are vague. What would you do? (Restaurant and menu selection suggestions welcome.)

Oh, trust me, when you have an auto-immune condition, you work through all of this with multiple specialists. It's a balancing act. Depending on what kind of med you're on, the time off before and after surgery changes. It's because our meds depress our immune system and slow down healing. The PsA meds are the reason once I decided on the surgery, I needed to get it done ASAP to reduce how long I'm without my PsA meds. But there's no way around time off at least some of them.

Gag. Yeah, when I was a rookie nurse, I gave that crap to a patient to drink, and she puked it right back up. Another nurse taught me to mix it in orange juice. Apparently it cuts down on the burning and makes it a little easier to get down and keep down, but I don't even want to know that that tastes like. Even the pills for K+ are awful because they are HUGE. And of course they take longer to take effect, and if your K+ is really messed up they need to correct it fast. Hugs for having to go through that.

There are definitely people who are hard draws. And excess fat makes it really hard to feel the veins and get a good stick. If we can't feel the veins, we're sticking blind. We generally know where stuff should be, so it's an informed blind stick, but it's still blind. Unfortunately, I have had WAY more people in the ER tell me they are "hard sticks" than actually are. There are a lot of nurses out there who try to blame the patient when they miss or blow a stick than to own up to it. They'll tell the patient that their vein rolled, or they've got valves. News flash: EVERYONE's veins roll, and EVERYONE has valves. Now, an athletic person (especially runners) will have more valves and sometimes it adds a level of challenge, but learning to "trap" a vein so it can't roll away from the needle is just part of developing the skill. And, certain treatments like dialysis and chemo, absolutely destroy veins. What we can find is fragile as spun glass. IV drug users get their veins scarred up and it's a real challenge to start one (but ask them, they'll know what's still accessible). People who donate blood a LOT or sell plasma tend to get their AC's scarred up badly, and we need to go somewhere else for it. Elderly patients' veins tend to be more fragile and also more engorged, there's a few tricks to sticking them without blowing up the vein. There *are* challenges. But if I had a nickel for every patient who told me they were such a hard stick, and I had zero trouble getting it on the first try, I'd be able to buy a car. When I would miss or blow a vein, I tried not to blame it on the patient, and just owned up to it. And I let the patient decide if they trusted me to try again or if they wanted me to get someone else.

I actually prefer forearms to AC because the AC tend to be so positional. But someone who only knows how to put IV's in AC's will mess up a forearm because it's less forgiving. The ones I absolutely despise are in the hand. I had one transected in my hand and bled so much it was like instant arthritis in the joints for a couple of weeks after!! Oh, absolutely if it's a primary or even the second site. But this was my 4th IV site (I was getting IV potassium, so I was shredding veins every 8 hours or so) I finally ended up with one in the elbow that lasted for my last bag of K. They started with my hand, which blew ugly and big, then forearm, another forearm, then finally AC. Those smaller veins clearly weren't designed to withstand potassium, at least in my body! And isn't it amazing what it feels like to have to absorb all that blood? My IV issues were by far the most difficult part of my hospital stay Ugh. I didn't realize you were getting K+. I'd never try to put that through a hand vein. Ew, ew, ew, ew, ew. Did they at least dilute it by piggybacking it to some regular IV solution? I think doctors should have to endure some of this stuff in medical school. They don't stop to think about how hard it is on the patient sometimes when they write orders. If the patient can tolerate volume, K+ comes pre-mixed in a very dilute solution that isn't nearly as hard on the veins, but the docs will order the tiny concentrated bags without even thinking about it. When I was bedside, if a doc ordered that, before I even went to get the meds, I'd ask him to order an additional volume of saline or whatever the patient needed so I could dilute it a bit into the veins.

Yep, and it was a blue one, so it was probably a 25ga. And she wasn't having an off day. She flat out told me she can't really feel veins, she needs to see them. She couldn't even feel them by popping the tip off her glove on one finger. Anyone who's done this knows you have to feel them to get proficient. She had the tourniquet on both times for about 3 minutes to find the veins in the first place. It's only by feel that you know what direction they're going, how deep they are, generally how big they are, and if they feel healthy or fragile. If she can't feel them with her fingers, then she's likely not feeling when she pops through the wall, which is why she transects. The one on my forearm you can see a mile off, she just went straight through it and then backed up until she got return. That's sloppy technique, and won't work for IV's, only blood draws. I knew as soon as she stuck that I'd bruise. I'm actually glad she missed my AC because she'd likely have transected it as well, and that makes a HUGE bruise for weeks. Like I said, I'm not upset for me. I just know enough about it to know that this is sloppy and she needs to look for a mentor to help her learn the proper technique. Who I really feel sorry for is people who have needle issues or feel the sticks more severely than I do, or who are hard sticks. I really and truly am an easy stick. I just hope she can recognize when she flat out won't be able to get it, and calls for help often.

I actually prefer forearms to AC because the AC tend to be so positional. But someone who only knows how to put IV's in AC's will mess up a forearm because it's less forgiving. The ones I absolutely despise are in the hand. I had one transected in my hand and bled so much it was like instant arthritis in the joints for a couple of weeks after!!

This is from yesterday's blood draw. With a butterfly. sent from mobile device

Yes it's not politically correct, but I do tend to agree. It's amazing that certain drugs work better in one race than another. We are all people and deserve the same rights and protections, but we have to recognize biological realities too. And something to keep in mind is that, at least from the evidence I've read, the distinction seems to be where someone's ancestry developed and evolved. So regardless of the amount of skin pigment, someone whose ancestors did a lot of evolving on the African continent may have different dietary needs that one whose ancestors did a lot of evolving on the European continent. I have a friend who has a lot of Central American heritage, and she has lactose intolerance likely because her ancestors evolved to get their Vitamin D from the sun. Virtually all of my ancestors are Scandinavian and Northern European, and they evolved to get their Vitamin D from milk instead of the sun. We both have very light skin, eyes, and hair. So the "racial" divides when it comes to things like dietary tolerance and benefit, is a lot more than skin deep, and should be treated as such instead of being subject to political correctness.

I did some internet sleuthing, and according to some muscle building forums, it appears that the stuff separates and/or gets pretty sludge-y if it's left to sit too long. And if you're mixing with milk, it can go bad if it sits too long. I personally have found that I can't drink the stuff if it's not ice cold. There were some theories about the Proteins and amino acids starting to break down, but most people thought that if there was any effect like that, it would be minimal. I hope someone else finds something a bit more definitive.

Didn't do a thing for me, I think mine was a different company. I ended up on one of those automatic shipping things and it took me months to get them to stop charging me and sending them. I think I finally threw them out or I'd offer them for anyone who wanted to try them. Didn't work a bit for me, might work for some people.

LOL. I loved working bedside as a nurse, but I have to say that the management to nurse relationship sucks rotten eggs. I was a mid-life career changer to nursing, from I.T. and I have never had the levels of disrespect in any other industry that I had as a nurse. I gave my supervisor and the scheduling person 6 months' notice of my wedding. I needed three shifts off, and had the PTO built up. We only got our shift schedules about 10 days before the start of the next schedule, and that's when I found out they only gave me 1/2 of one shift off, and it wasn't even on my wedding day. I had 4 out of town guests in my own home before the wedding, and a dozen people coming from out of town. I'd already re-scheduled it due to scheduling conflicts as well as not being able to get off for it several months before. I worked in the ER. Came in one night with what I thought was just allergies, but by a couple of hours into my shift, it was clear it was actually pinkeye. Was told they didn't have anyone to cover, and I had to finish my shift. WITH PINKEYE IN AN ER. Short staffed for a shift? Does management come in to cover? Nope, they just add more patients to the nurses' loads. I worked in one ER where I carried TWICE the recommended load for patients, and they didn't adjust for when I had super sick patients for the entire shift because the ICU was in overflow. That same ER when I hired on told me I was to work weekend shifts 1 out of 3 weekends. Then they proceeded to schedule me 5 weekends out of 6, and told me to suck it up. And I had it much better than floor nurses. Hug your nurses, they need it.

I married two narcissistic men, wasted 10 years on each of them. When I think about the life I could have had, it makes me sad. However, it's also been part of what's molded me as a strong independent woman. Here's what I've learned in the process, FWIW. Take what works for you, leave the rest. My self love and self esteem HAS to come from myself, not from my relationships. As scary as it is, it really is better to be alone than to be in a crap relationship. I need significant time (like a year or more) after a relationship ends to get the right perspective on it, and get back to who I really am, because good or bad, I do change when I'm in a relationship. If I don't get back to my normal before starting another, then it's really going to be messed up. Alone doesn't have to mean lonely. There are people out there who will be my friends and chosen family. Not to mention my blood family. And if I want, I can even have physical relations without being in a relationship. (But I urge great caution with that one, I've only had 1, maybe 2 situations that truly worked out as friends with benefits and didn't get really messed up, and that's in 46 years of life (so a little under 30 years of dating) so the odds aren't good). There *ARE* good men out there, and even a few that are perfectly right for me. The trick is to recognize them when they show up, because they aren't typically the ones that make my heart flutter at first sight. (That is actually a red flag, because it means I'm playing into my emotional baggage and picking the exact WRONG ones.) The right ones are the ones where the relationship gradually gets deeper and stronger as you get to know the person. Very often, the right ones don't start showing up until I decide to quit looking for love and just enjoy my life. And last but not least Everything Will Be OKAY.

I suspect (but didn't work in surgery, so am guessing) that they're not the default option, the doc likely puts them in if s/he sees something that indicates there might be a place where Fluid collects that s/he doesn't want. Not necessarily a complication, but maybe something that they think might become a complication so they head it off? My surgeon said that she sees so little blood loss in her surgeries that I don't expect one.

There's a bunch of different types of drains. I should have specified that this is the one I saw most commonly when I worked ICU here in the US, for abdominal drains. There's reasons to choose each type of drain, including the surgeon's personal experience and preference. The ones I hated the most were Penrose drains because they're "open" as in no collection container, so the dressing changes can be heck.

Following. I haven't noticed that instruction (haven't looked, honestly), and haven't seen this question before, so I'm also curious as to what's up. From what I've heard it could take an hour or more to get a shake down. If I need to figure out the proportions to mix up just a little at a time, that's good to know.

This is a typical post-op drain. It's basically a tube that has openings along the end and is left in the wound to drain out blood, tissue, and other fluids that can collect. There is a bulb at the end of the tube that applies a tiny bit of suction to the tube to help the Fluid get pulled out, and also collects it. The bulb comes off when you need to empty the collection (but always measure the amount). Some people experience discomfort, some have flat-out pain, each person's experience is different. Not everyone gets them, I don't know what the surgeon sees that tells him or her when someone needs one. From what I've heard and researched for the sleeve procedure, normally they're taken out before you're discharged home unless there's something a little abnormal going on. Hope that helps. (Patient education is one of the things I miss most about hands-on nursing.)