Sunday, October 26, 2014

HG Treatment Post 3: The Site

This is the third post in my HG series on Zofran/Reglan Infusion Pumps.  To see the intro post, which will list all other posts in the series and link you to them, please go here.  If you are here because you are about to start an Infusion Pump, don't worry!  For all the garbage that may come with them, it is by far better than the crippling illness that HG is.  

So here we are, at the part that may be freaking out the most.

Allow me to preface this post by saying that while I am not a masochist, I am not a person with needle issues.  I, under normal health, have no problem with seeing skin get poked.  The troubles I have had with IVs (another story for another time) has made that less true, but the infusion sites themselves are no biggie to me.

I know that is not the case for everyone.  If you cannot stand the idea of poking yourself perhaps you have someone who can support you.  I know my husband, for all his manly, bearded Eagle Scout glory, cannot stand needles and gets light headed just hearing me talk about this garbage.  I respect that, in all seriousness.  He is my support network in the ways I need, I don't need him to do this.  You may, and that is okay.  Did you hear me, that is okay!

Now if you have no one who can help do the poking, trust me you CAN do it!

You may also get used to it.  Bottom line, I think the ickies of this are far more tolerable than anything HG dishes out when unmedicated.  It is worth it, you are a warrior, hang in there!

Now to the details.  Deep breath, I will include pictures of everything except me actually piercing my skin.  This said, for the really squeamish, there will be pictures of the catheter IN me, though you can't see anything I know that bugs some people.  

So this is the Orbit.  It comes in a little sterile pack with the tubing and catheter ready for use.

This is my supply set up initially.

The trucks are not necessary, but my fan kept blowing the stuff around and it helped.  LOL

My set up looks different now, but I will include both.  Taking this one part by part first .... that looks overwhelming and is really cluttered.  I did not take the picture for the blog, I took it for me so I would have a check list of the stuff I would need.  So it isn't very pretty, and things like the Notebook are not necessary for the purposes of site change (but it is necessary as I will discuss in post 4).

So in that picture we have the Orbit, which is the actual catheter and tubing (more detail in a sec).  The clamp is there so that you don't accidentally give your self a bolus of medication while changing sites, but I don't use it anymore.  I just take the tubing off of me first thing so that if I accidentally squeeze the syringe it won't push meds into me.  Seemed easier.  Skipping the Tegaderm in the center for a second, then there is a bandaid for the old site, alcohol wipes, the sharps container to drop the new site's needle in.  Also the medicine syringe is necessary and the instructions and paperwork are in the background there because I always had them at first. I am not even sure where they are now, I just don't need them.

Now that Tegaderm.  I have ridiculously sensitive skin.  All adhesives make me react, so the prospect of having anything stuck to my skin 24/7 was daunting to me at first.  Initially my nurse gave me Tegaderm, which is like the love child of Saran wrap and super sticky tape.  Tegaderm is often used in IVs, you can see the clear stickery sheets in almost all of my IV pictures, including this one:

Tegaderm is the clear sticker under everything,
everything sticks to it and not me to try to reduce my reaction.
So I would sterilize the area with alcohol, let that dry and stick the sheet of Tegaderm down.  Then I would actually pierce through the Tegaderm so when the Orbit stuck down it did not touch my skin, it was all resting on this Tegaderm.

Not a good picture, but you can see the plastic-like stuff
stuck to me around the circular part?  That is the Tegaderm.
Since Tegaderm is supposed to be hypoallergenic (a word that makes people as allergenic as me laugh) it was supposed to help.  In a lot of ways it did, but it is the stickiest stuff ever AND because I had to change so often (10-12 hours) that stuff was still in its prime.  Thus, it hurt like a mofo to remove.  Add to that I had those nasty site reactions mentioned in post one?  Oh it wasn't pretty and it certainly hurt.  So we switched to this stuff, Skin Prep.

Skin Prep is weird, it wipes on like an alcohol swab (which it has in it, so it is sterilizing as I use it) but dries like a thin almost waxy coating.  The adhesive of the Orbit then sticks to that, not my skin.  It has been very helpful.  If nothing else, removal of the Orbit is no biggie because while it stays in place okay it does not bond with my skin as strongly so it comes off better and with less trauma.

Now this is my present set up.

See. less stuff and it is easier for me now.

Now the Orbit pack itself.

First there is the tubing, which screws on to the syringe and delivers your meds to the catheter.  

The catheter initially looks like this on top, the part you hold.

The underside of it has the needle with the catheter around the outside of it.  This one still has the shipping protector thingy around it so it will look huge.

You can also see the paper backing for the sticky part that actually will go against your abdomen (or thighs).

Now to take off the paper and the shipping thingy.  Here is the catheter around the actual needle you use.  If you look closely you can see the catheter stops like half way down the needle.

It is not very big, the needles they use for IVs are massive comparatively.

Once you prep your skin (with alcohol or Skin Prep or whatever as long as it is sterile) then you pinch up what you can fat wise in your abdomen, flank, or thighs and push that needle in at 90* angle.  Once you did that it will look like this:

It isn't comfortable, but the faster you get it over with the better.

Then you remove the needle part by pinching those tabs on the side and pulling out gently.  You don't really feel anything except maybe emotional relief at this point.  This is the needle without the catheter on it.

Take that needle out and this is what the site will look like now.

That is the exposed catheter thingy, no giant hole in your side. There is no visible hole there, really.  I know there is some kind of something but its not whatever I had in my head when I imagined it.

Now you snap the tubing's end piece on.

Boom.  You did it!

Now you have to push the Yes/Start button on the pump a few times to resume the session and keep the meds flowing.  This was all discussed in post 2.

Now, if you are wondering what the catheter itself looks like, this is one that I have removed from myself.  This one was in me, so there is medication in it if you look, but no blood and gore.

Not so bad, right?

Oh and there is also this thing in the Orbit packs.

I have no freaking clue what it is or what it is for.  LOL My nurse didn't either so it is apparently not important.

Once they are in I don't feel them now that I am on a medicine by body accepts.  With the Zofran I had a pinching feeling initially that increased to discomfort the longer a site was active.  Reglan has been accepted by my body and does not hurt.

As I have lost weight, a double edged sword to say the least, poking myself has gotten a little harder.  When I started I was padded enough to have a decent amount of fat to poke into.  Now?  Well, I have a lot less, so it is a little uncomfortable but if I get it over with fast it isn't so bad and I have some suggestions in post four about this too.

When I remove a site sometimes I have a mark from it, and sometimes a little bit of medicine (and occasionally a tiny bit of blood) will come out of the site.  Not painful either, except when I was reacting to the Zofran.  Slap a bandaid on it and move on.  For the sake of clarity, this is what one of my Zofran sites looked like.  It is not an extreme reaction so you may look like this with it because Zofran is a skin irritant.

Now I have just dots and slight itchies from the adhesive because that is how redheads roll.

So that is the the tour of my infusion sites for the Reglan/Zofran pumps.  Next up is the random hints and tips I have that I figured I would stick in one post to try to not make each of these a total novel.  As always, please feel to ask questions and know that this is meant to help not explain. I am not a medical professional, just someone sharing her experience.


  1. Thank you so much for these posts! I am 14 weeks with HG and I've been on the Zofran pump for a month. My infusion sites are really starting to be irritated and I DO NOT react well to Reglan. I'll be receiving the prep swabs in my med shipment next week and I'm glad to hear they seem to do some good. Anyway..appreciate these blog posts and all the info from your experience thus far.

    1. I am so glad you find anything here helpful! I wrote all of these knowing it would have been something I'd read before (and even now) so it makes me happy to think it *may* help someone! I hope the Skin Prep helps you, it helped me a lot but Zofran is just irritating. I was told it can take a month for you to adjust and it can get better after that, so my fingers are crossed for you that it will ease up. I know a lot of people cannot do Reglan so I am grateful I can since the Zofran was not going to work for me. Best of luck to you and keep me posted how you're doing!