Forum Discussion
A tip to avoid pain during observations during chemo administration
IF YOU'RE NEW TO CHEMO, WATCH OUT FOR THIS.
A few weeks ago, during my chemo infusion, a "pool" nurse without chemo experience came and did my obs half-way through. It hurt like hell. Now, I've always had a very high pain threshold, and this wasn't 10 on the scale; but it hurt a lot: at the cannula site and a sliding ache all the way up the vein it was plugged into. I was massaging the arm to soothe it. I told her it really hurt and she said, "It's probably the pressure."
Later ,I told the real chemo nurse. She said, "Oh, I always pause the chemo when I do the obs during it." I had never noticed that they did that. Today, a nursing student came to do the half-way obs and he made no move to pause the chemo. I said, "You ARE going to pause the chemo, aren't you?" He looked mystified. I said, "If you don't, it will hurt me a lot." He said he's not allowed to stop chemo and went over to a senior chemo nurse. I heard her ask, "Who wants to stop it?" He gestured at me. She came flying over, "Are you okay? Are you having a reaction? Why do you want to stop it?" I said, "I don't want to stop it. I just want it paused while he does the obs or it hurts a lot." She said, "Of course." And paused it. After a while she came back and restarted it when he had finished the obs.
I'm stunned that they don't train students to go and get a chemo nurse BEFORE they're ready to start the obs. It should NOT be up to the patient to manage this: to alert inexperienced people to this. I only learned the hard way, by suffering the first time, and then having to tell the nurse and thus learn what should be done.
A few weeks ago, during my chemo infusion, a "pool" nurse without chemo experience came and did my obs half-way through. It hurt like hell. Now, I've always had a very high pain threshold, and this wasn't 10 on the scale; but it hurt a lot: at the cannula site and a sliding ache all the way up the vein it was plugged into. I was massaging the arm to soothe it. I told her it really hurt and she said, "It's probably the pressure."
Later ,I told the real chemo nurse. She said, "Oh, I always pause the chemo when I do the obs during it." I had never noticed that they did that. Today, a nursing student came to do the half-way obs and he made no move to pause the chemo. I said, "You ARE going to pause the chemo, aren't you?" He looked mystified. I said, "If you don't, it will hurt me a lot." He said he's not allowed to stop chemo and went over to a senior chemo nurse. I heard her ask, "Who wants to stop it?" He gestured at me. She came flying over, "Are you okay? Are you having a reaction? Why do you want to stop it?" I said, "I don't want to stop it. I just want it paused while he does the obs or it hurts a lot." She said, "Of course." And paused it. After a while she came back and restarted it when he had finished the obs.
I'm stunned that they don't train students to go and get a chemo nurse BEFORE they're ready to start the obs. It should NOT be up to the patient to manage this: to alert inexperienced people to this. I only learned the hard way, by suffering the first time, and then having to tell the nurse and thus learn what should be done.
14 Replies
- The gun stabber at day oncology (they called her that!) clearly had x-ray vision, she was seriously good! But most of the day oncology crew had a lot of skill, and technique, particularly with uncooperative veins. I could never work out why the skilled could not train the unskilled, at the same hospital.
- I don't understand why they don't get some of these super vein-finders to provide tuition to the others. Last week, someone said "Rowena feels things with her fingers that I can't feel." They could also observe. Suoerman Michael does a thing with slapping my warmed arm. Surely he could demonstrate and explain the purpose of that (not necessarily on a patient) and how it makes the veins more visible/ accessible ...? The better ones also have a better warming process - the heat packs above and below the arm, with protective sheets, all wrapped in a warmed blanket. Others don't bother with the blanket. Should be standard practice - not personal approach.
- For some reason, for that first episode I had two nurses who, who didn't have the long experience of chemo nursing (I was in the cold cap diffusion centre so very small). The rest of them have been fantastic, fortunately, and if anyone came in who had problematic veins, they would call on one of the nurses, Elda, who always gets it in. The second time I went for my first chemo, they did it by cannula as the area around the port was so bruised and sore. I, of course, WAS anxious that time, and the first nurse tried to get it in the vein but struggled a bit. She immediately called Elda over and she got it straight in with no difficulty. For some reason (can't remember why), I then had to go for a scan. Bloody radiologist insisted that he had to put a larger needle ABOVE the cannula even though I explained and asked him not to, and he was as rough as guts, probably because he was annoyed at being questioned. When I got back to the chemo centre, phone calls to wherever to find out how long they had to wait before administering chemo because the nurses really didn't want to puncture me again. Not surprisingly, I was really frightened each time I had the AC doses and I remained at high anxiety levels for most of the chemo regime, only really settling down towards the end
- @Kattykit Patient. Centred. Care. :#
- We are the ones they stick the damn needles in time and time again, do they think they know our bodies better than we do...sheesh!
- Oh and it's nigh on impossible not to catastrophise breast cancer at some point or another. How insulting and insensitive. They don't know your life and circumstances! My diagnosis WAS a catastrophe for me and my poor family. FAAAAARCK a bloody duck this makes me FURIOUS.
- Totally agree with @Afraser. My second chemo infusion began with a chemo nurse (who wasn't a child) waggling the needle around under my skin trying to find the vein for FIVE minutes. I timed it. Insane. It was very painful. And I was made to feel like a child when I requested a different nurse for the next time...
My veins are hard to find at the best of times but they're worse now after the last eight months. I've always told medicos that I'm difficult in the vein department but mostly they view that as a challenge, only to be red faced some minutes later.
The 'best' one was when I was pregnant with my second and I went to do the fasting blood sugar test. Drank the sweet drink, waited and then went into the room where three phlebotomists worked all day, taking blood at the Royal Women's. I warned her about my veins. "Oh that's fine. I've been doing this for eight years, never collapsed a vein yet"... Well of course 30 seconds later she'd collapsed my vein and I had a foot of bruising spreading up and down my arm. She went scarlet and struggled not to cry. I felt so sorry for her! - @Afraser Ooh yes. It's astonishing. The pathologists at RBWH are great - they get the spot for the blood test every time. But every week when it comes time for cannulation for chemo I have to ask, "Are you one of the Top Gun Vein Finders who will guarantee to get it first time?" They immediately go off and get someone else. I shouldn't have to ask. I even phoned the oncol nurse last month and asked if because of the number of failed attempts and the increasing fragility of my veins and the number of treatments left to go, was it reasonable to ask (I'm very polite!) if I could have a Top Gun every week. They agreed. But still, it's not happening. I have to be assertive.
- Oh, @Sister ! I have so many stories about misinformation, disinformation, withholding of information, breaches of the Australian Health Care Rights thingy, since all this began for me ... and I've been rational and respectful but firm and assertive about advocating for myself all the way through. My bc nurse told me the morning after surgery (get 'em when they're down, hey?) that I had "catastrophized everything". When I asked to see a psychiatrist in hospital, a child one came and took my medical history (Her: have you ever had depression or anxiety? Me; of course; everyone aged 74 has at some stage!) and when I asked her, "Do you understand why I'm anxious?" she said, "Well because you've had anxiety in the past it's logical you would now." We need to manage things for ourselves. That's the main reason I started this post.
- I am constantly amazed at the number of non-oncology nurses who can't insert a canula or take a blood sample. I have had two instances where an anaesthetist has been called (I wasn't having any anaesthetic!) to do the job. One badly inserted canula caused my hand to swell up badly (at night) before I noticed it and asked for it to be removed.
