Vessel problems with i.v. therapy

Question

Dear experts,

I am 31 years old and currently in the second CF stage, and before all else, let me say that a port is not yet an option for me. I have already had several i.v. therapies, although the last three have not been completely without problems. The therapies as such were successful, but each time a part of the vein between the entry point of the needle and the tip of the cannula, i.e. three parts in total, were destroyed. Therefore, fewer and fewer vessel areas are remaining that can be used. I am wondering how this could happen three times in a row. Did I disregard any danger signals, should I generally have changed the cannula earlier (5-7 d) since the aggressiveness of the drugs severely irritates the veins, or are there other preventive measures? Thanks in advance for your answer!

Kind regards.

Answer

Dear questioner,

you are asking about “vein care” or rather, how to prevent your veins from being damaged by i.v. antibiotics therapies. You are also ruling out the option of a port catheter at this point; therefore I will exclude this option (although it is a good one in many cases) from my answer.

The conditions of the veins vary greatly among CF patients (as they do among all other people as well). Usually, CF patients can receive i.v. antibiotic therapies for quite some time without any major vein damage. Some patients, though, for reasons that are not always clear, are prone to local vein inflammations and therefore to scarring of the veins due to indwelling cannulas and i.v. antibiotics application. As a result, it is possible that the veins will not have recovered by the time of the next i.v. therapy. This will make puncturing the vein with the aim of inserting an indwelling canula distinctly more difficult, and it may even become impossible at times. Should it come to that, it is advisable to decide about a port catheter already earlier.

At any rate, you have to be very strict with hygiene when dealing with infusions. Any “manipulation” of the indwelling canula should be reduced to the required minimum. In addition, the necessary antibiotics can be administered in larger amounts of solutions (you will have to talk to your doctor or pharmacist about the details). This does prolong the infusion time, but it can be easier on the veins. You should also pay attention to “danger signals” (pain at the injection site, local redness, itching), so that a new indwelling cannula can be applied if necessary. Changing the cannula too often should be avoided as well. There is no rule, however, as to after how many days an indwelling cannula has to be changed.

Generally speaking, puncturing the vein can be made easier by making sure the veins are properly filled, e.g. by drinking sufficiently or moderate weight training of hands and arms. Warm temperatures will widen the veins; in this case a wristband can help. A well-placed indwelling cannula will also prevent inflammations later.

Concerning your individual problems with vein inflammations, you should also talk to your CF doctor so that he/she can decide together with you about the best way of proceeding.

Kind regards
Dr. Christina Smaczny

30.07.2012