Robyn Shoemark is Clinical Nurse Consultant, The Children’s Hospital at Westmead
Helen Starosta is Clinical Nurse Consultant, Royal Hobart Hospital
Home treatment and prophylaxis have become a way of life for people with haemophilia. It is very important to look after veins as you will need to use them for a long time. While giving factor may be challenging, you or your child’s caregivers are the best people to administer factor replacement therapy using veins once you know how to do it.
WHAT ARE VEINS?
Veins carry blood back to the heart and lungs from around the body. They have thinner walls than arteries; they lie closer to the surface and do not pulsate. The veins closest to the skin’s surface are used to get blood during a blood test or to put medication into the body.
Having good veins to give factor through is not just about good luck. Learning how to do this properly and then looking after veins is important and requires work.
Have you ever noticed how body builders and brick layers usually have big, strong veins? This is because of the upper arm exercises and work they do. You can make veins bigger in your arms by doing some simple exercises.
EXERCISES FOR VEINS
1.Squeeze a sponge ball in your hand. Start with ten squeezes daily and build up to 50 squeezes per hand daily. This exercise helps to develop the supporting muscles.
2.Place a tourniquet around your upper arm. It should be tight enough so that your veins stand out in a few minutes, but not so tight that you can’t feel a pulse at the inside elbow. Squeeze your fingers in and out with/without a sponge ball until your arm gets tired. Loosen the tourniquet and rest a little, then repeat this exercise again. If you do this frequently, at least twice a day, it will improve your veins.
How do these exercises improve your veins?
When you do these exercises, your muscles tighten, clamping off veins that run through them. This makes all the blood that flows into the arm return through surface veins. This causes veins to become larger and stronger, making them easier to find and use.
Remember, it’s like any other exercise. It only works if you do it regularly, and it will certainly help with your infusions.
VEIN ROTATION
Medicines that are given through veins can irritate the walls of the veins. Changing which veins you use can help decrease irritation and scarring.
When you put a needle in your skin, it leaves a small hole that needs to heal. The same is true with your veins. You can keep your veins in good shape if you let them heal before you use them again. If you don’t let your veins heal, you may be at risk of collapsed veins or infections.
Rotating your vein is often recommended, where you let one spot heal while you use another. A vein usually takes a couple of days to heal. It is also useful to have a backup vein that is used to being injected in case you have issues with your regular vein.
TIPS FOR TREATMENT
What can you do to make things go more smoothly when you need treatment?
The following are tips and tricks which may help you:
Clean – Always wash your hands before you start and have a clean area to make up and give your factor.
Drink plenty of fluids – make sure you have enough to drink before you try to give your factor so that your veins are plump and bouncy.
Keep warm – if you are cold, your veins will shrink and will be much more difficult to find. This is sometimes a problem in winter so it helps to put on a jacket to keep warm. Have a warm shower or bath. A warm breakfast or cup of hot chocolate/milo will warm you from the inside. If you are still having problems then a heat pack over the vein you are using is a great way to warm you up and help make it easier to find your veins.
Environment – makes sure there is good lighting where you are sitting and you are comfortable and relaxed. If you are stressed or scared then your veins know this and make it more difficult to find them. Sit somewhere comfortable and if you need to be distracted, turn on music or the TV. Take a few deep breaths before you start if you need to calm yourself.
Exercise – being fit and healthy means you will have better veins. A healthy weight range also makes it easier to find and feel your veins. Just before you have your factor, doing a quick round of exercise such as running on the spot or star jumps will help get your blood pumping and make finding your veins easier.
It is better to use a plump bouncy vein that you can feel than a vein you can only see. If a vein is plump and bouncy it will be easier to access than a vein that is visible but flat. Take your time to feel and get to know your veins and the direction they are running.
Position – make sure you have your arm below the level of your heart. Dangling your arm over the edge of the bed/chair before you access your veins will allow gravity to increase blood flow to the area and the vein. After applying the tourniquet squeeze a rubber ball or make a fist or flap your arms up and down to help increase blood flow.
Use distraction for small children – TV, DVDs, iPad, toys, bubbles, Buzzy Bee, another person. Anything your child likes is helpful.
Pain relief – using anaesthetic ‘numbing’ creams. Remember to remove and clean the area well. Finding the veins is easier if the cream has been removed for around 10 mins before trying to use the vein.
Avoid pressure on the needle insertion site during an infusion or when taking the needle out. Remember to release the tourniquet before you start infusing your factor.
Apply pressure after the needle is removed to make sure the bleeding has stopped. If you do not apply adequate pressure for long enough then you may get a bruise over the vein making it difficult to feel when you next need to use it. Using a pressure band aid will help prevent bruising. Looking after your vein makes it much easier to find the next time you need treatment.
Rotate vein sites as needed – you may not need to do this but if you are having problems with the vein, it is always good to have an alternative to use.
If you need a blood test – ask the health professional you are seeing if you can access your vein yourself or if they could use a different vein to your regular vein.
Ask for help – sometimes you will have problems despite your best efforts. Remember, it is ok to ask for help if you are having problems.
For more information about looking after your veins, talk to the haemophilia nurse at your Haemophilia Treatment Centre.
