Vein irritation during IVIG

I forget what the term is for this, but I have heard of it.

It can be caused from a few things.

1) The vein could be too small as your nurse suggests

2) The nurse may have not gotten the IV in all the way

3) If you are using the same vein each time it can become irritated from the IVIG.

I would ask the nurse to use a new vein for each infusion. Also try drinking more water before each infusion to puff your veins up.

Good luck,
Kelly

I had that happen to me I think they put heat on that area to help with the pain but then next day switched arms. I think it’s called Phlebitis.

Phlebitis Symptoms

Superficial phlebitis

* There is usually a slow onset of a tender red area along the superficial veins on the skin. A long, thin red area may be seen as the inflammation follows a superficial vein.

* This area may feel hard, warm, and tender. The skin around the vein may be itchy and swollen.

* The area may begin to throb or burn.

* Symptoms may be worse when the leg is lowered, especially when first getting out of bed in the morning.

* A low-grade fever may occur.

* Sometimes phlebitis may occur where a peripheral intravenous line was started. The surrounding area may be sore and tender along the vein.

* If an infection is present, symptoms may include redness, fever, pain, swelling, or breakdown of the skin.

Sue

I had that during IVIg but only while I was on Prednisone. My doc took me off the Prednisone after 2 days b/c it was making my veins get irritated and ache. Soon as the Prednisone was out of my system I was ok

i used to get ivig two days in a row every other week and every day two of the same IV i had phlebitis. now i get one day once a week, so only one day of vein being used and i haven’t had one episode of phlebitis. i would ask for a different vein for each day and see if that helps.

Yes, I got phlebitis the last day of my last infusion. They recommend warm soaks several times a day. I had minimal pain but you could probably take Advil or some other anti-inflamm. for it. I would have them rotate sites more often if I were you.
Margaret

Immunoglobulin is tough on veins and phlebitis is, unfortunately rather common. As others say, using larger veins if possible, changing veins, and drinking well can help as can slightly slowing the rate of infusion. I had the same IV for four days before and the vein was not happy on the last day. Warm packs and freedom to let my hand move helped a lot. If one keeps using a vein after it starts getting phlebitis, the vein can get inflammed enough that it clots. Often if you let that vein rest, it may recover and you can use it again.
WithHope for a cure of these diseases

I would definitely get a new IV for each infusion. What you experienced was the beginning of phelbitis. Warm compresses several times per day to the site, help to alleviate this problem.

You’ve received some good advice here, but I am an infusion RN and it is NOT from the “nurse not getting the IV in all the way”. An IV is either ‘in’ or not in. There is no in between.

Also, if were “partly in”, you would have had some extavasation (when the fluid-IVIG, in this case- leaks out of the vein and into the surrounding subcutaneous tissue). That would have resulted in a puffy, or swollen IV site. However, even if this happened it would not be a huge deal, as another route of administration is the subcutaneous route!

HTH

Jdunk – We do have experience with an IV not being in all the way. Emily experienced a red irritation at her IV site during an infusion in the hospital. It was determined by the head RN that the IV was not in the all the way. The theory was after the initial access the catheter slid out of the vein slightly & the nurse didn’t realize it. That was one heck of a day, let me tell you. They tried 7 times to get a good IV going on Emily. It was awful.

That’s what I meant when I said ” The nurse may have not gotten the IV in all the way”. I should have worded it better.

That same day another catheter actually kinked inside of Emily’s vein. It wasn’t secured properly & when Emily moved her hand away they say the catheter kinked. We only found that out when they tried to sedate her into “twilight” to do a spinal tap & they couldn’t push the meds in.

We’ve found that crazy things can happen when you are dealing with a nurse who isn’t the greatest at starting IV’s. Basically anything that could have gone wrong that day did.

Kelly

you try to be, keeping a catheter perfectly set over two or more days can be a tricky thing. It never worked for me, the things seemed to shift/push-out the other side of the vein or whatever. I get a new catheter for every infusion, to me it’s ultimately safer that way and I strive to keep that site, as still and the muscles as relaxed as possible to help things along.
My own veins are sort of scarred and sore from all the poking, but again, my nurse will request to my neuro a port when the time comes.
You have gotten very wise advice from others here – including the rotating of the veins and being sure to hydrate. You might also ask your neuro about this reaction as he might suggest pre-meds or other alternatives to help you feel better overall during and after the infusion.
Hoping things get less painful in the future!

I got a hard lump, soreness, bruising at a site that was used 7 days prior. Yes, I’m on Prednisone, have small veins, and didn’t drink as much water as my first Ivig 5 day treatment. I used Arnica cream on the site and it cleared and felt better. My first Ivig was outpatient, but this one was during a hospital stay, so I kept the IV in for as long as possible. The reason why this site blew is because one of the med students that was being taught to do strength testing actually grabbed it, even though I reminded them all that I had it in (I had a sweater on). lol Hope this helps.
Dawn

Do they always use ports for the IVIG”s? And I have never had one before! May have to get IVIG’s and was wondering what they do when they start one! Have had IV’s but never had a Port! I have heard they hurt! Is this true?

Linda they can put IVIG through a port. I have a port-a cath. I started with neurological lyme disease and had the port put in for IV antibiotics. After the dx progressed to cidp I chose to leave the port in place because my peripheral veins were very scant.

While my veins have improved significantly since starting IVIG 17 months ago, I still need a good phlibotomist(sp?) to get a blood draw without bruising.

Hi Erin and Jersey! Thanks for answering my questions. I’m just a big chicken to needles and hate needles. A childhood thing that I never outgrew! LOL! I have heard about Ports but really never knew what they did. I have bad veins too. The rolling kind or ones that blow before the needle gets placed in my arms. When they prepped me for surgery a few weeks back, they had to poke me 3 times and the 3rd time, I started getting ornery! 😀
Jersey! Hope your arm is feeling better today. I know that has got to hurt! Hugs!
Linda H

Kevin has a port, and it is a Godsend. Our infusion nurse has a patient who has been getting ivig for a couple of years now and his veins are shot. He refuses to get a port. This months infusion will probably be done through the veins on the top of his foot our nurse told me. Every time Kevin is accessed (with the acception of the first two times before we figured out Kevin needed an 1/12 needle instead of the 3/4 protocol) it is a slam dunk, done, no problems, no burning, nothing. He is much more relaxed. They just keep him accessed for the 3 days (yippee, used to be 4) When we used to use veins in his arms, he had phlebitis every time. It was painful. Good luck.
Dawn Kevies mom

Hey Mason has had a very bad time with his veins for the past four treatments. I put off his treatment for almost 8 weeks, trying to give his veins a rest. I stopped the treatment tonight. They are trying to put him to sleep and then run it fast. His arm is hurting so bad, he is screaming. The Dr says there is nothing wrong, it is just Mason being difficult. I am so ready to go home, if I had anoth solution I would. Any suggestions. Laurie keeps telling me port.

Ditto the port. How is Mason doing? Have not heard from you in a while. Kevin used to get it in his veins, it would burn so bad and usually have to be reaccessed on the 3rd day of 4. We have had 2 blips on the screen regarding the port. The first stick after surgery (2 days post) was rough because of swelling had to use 1 1/2 inch needle. We also had a little trouble last month, had to go to the surgeon, he was able to get it. Other than that in one year of having it, all is well port wise. If you do get the port, ask for the surgeon to leave it accessed after surgery so you can infuse the next day (we had to depends on when your next infusion is) and when you put the emla cream on, use glad press and sel instead of the tegaderm. Makes for a better experience.
DAwn kevies mom

Hey, thanks for the reply. we have been doing good the past eight weeks. He has had the normal winter illnesses. He has been getting weak and tired the past two weeks. I decided then it was time to get a treatment. It was nice those weeks to believe we were normal again. I was totally in denial. I guess I have been the past year. I was hoping he was getting older and learning when to rest. He told me this summer, Momma if I go outside and play, I will forget the pain and it will go away. LOL We learned it just got worse when he finally rested. All I can say is I don’t know. His Dr thinks he is God. If he can’t figure it out, he takes it out on us. What can we do besides the IVIG? Dr M said we would do steroids every week. Lori said don’t do it, I agree with her. Mason and IVIG have never gotten along. I still believe he was allergic to it when he first started getting it.

How are yall doing? How is school going? I don’t get to see Laurie anymore, there treatments are at home.

Hey, How are yall doing? I answered you back last night. LOL I typed a long page, I must have hit something besides post. Oh well it was late 12 or 1 in am. Mason finally stayed knocked out and they ran his IV at a rate of 70 it took 6 hrs. I got to worrying about the side effects. He is drunk right now. We will wait around for a couple of hours, before we leave.

I put his treatment off for eight weeks, trying to give the veins and us healing time. It was nice acting normal, but we were totally in denial. It hit us in the face like a Mac truck yesterday. We stopped the treatment right after it was started. Dr Maertens blames Mason, he says he is just difficult or being a brat. I know different. We will see what is going to happen when Dr M gets here.

If he can’t take the ivig what othe option is there?hgh

Trish,
Have you tried switching brands? Gammunex is supposed to have the least side affects, but CAN be difficult to attain sometimes. If you use them direct, they can get you on a program that will guarantee it and theyu hook you up with a nurse. (KEvin loves his nurse thats why we can’t do it) About the steroids, at the symposium we just attended a study was done that indicated steroids showed no added benefit when used with ivig. I have some papers on it. You may want to check out a post by With Hope Titled notes or something, it outlines the symposium in detail. As well I have some literature they handed out siting abstracts, I could fax them if you like. does Mason get Gammaguard SD? That was a particular type that Kevin found extremely irritating. If you are not happy w/ Dr. M, is it possible to switch? How about Sladky in Emory? Why do you think ivig is not working? Could the treatments be too far apart? Kevin is at once a month. Currently we are in a backwards slide, as you stated, there are fall sickness’s here and that is what is bringing Kevin down as well I suspect. we go to doc on Fri. will ask for a load or two. However, when he is up and running on his schedule, he is able to play like a wild man and not feel too bad. Dr. M is wrong, Mason is not a brat as you said, he is a kid, a boy, Dr. M just needs to figure out how to get this under control so Mason can play. Let me know if ytou would like me to fax you the info.
Dawn Kevies mom

Hey, How are you doing? How is Kevin doing? We have had a good eight weeks. I had put off coming to see if the veins would heal, I was wrong. They finally knocked him out, they ran his IVIG at a rate of 70 over six hrs. He is still drunk from the addivan, but he didn’t scream all night. His arm still hurts. We will see what Dr Maertens says when he gets here. Boy I am not looking forward to that.

On the good side Mason is doing great in school. He almost has a photo graphic memory. He is so smart. I would be crazy if he was not. I told him, if he were able to go to school everyday they would have to move him up a grade. When he is at school, he helps the other kids with there work. Mason has the biggest heart in the world. He will walk by and say ” Mommy we need to pray for them, or we need to pray for sick people with diseases.” I wish I could be more like him. Since my brush with death in March, I am more laid back. I try not to panick as fast. LOL

I just don’t understand people sometimes. I know the doctors are stressed and the see death all the time. I hear well he is alive and he looks good. They say you just don’t know. I just think, you just don’t know. I am the one who carried a child for edght months knowing he was going to die. I am the one who almost dies giving birth to him, so I could give him any chance to live. I know things could be worse, I have been there. I know Mason is sensitive, and panics, but the judging from the medical staff drives me crazy. If they would admit, hey, “I just don’t know the answer.” that would be so much easier to handle. I guess we can’t wish for everything. I better go, I have retyped this same page for the third time. LOL Maybe this time it will post. Have a great Thanksgiving!!!