The bruises on my arms have finally faded since my Remicade (infliximab) infusion a little more than a week ago. My nurse eventually found an agreeable vein after three tries. At least only one nurse had to try this time. Sometimes, my infusion nurses play pin the tail on the donkey with me until someone succeeds.

Fortunately for them, I don’t mind being poked more than once. I’d rather have the nurse give up on a vein and stick me again than dig the needle around in my arm to get the vein to cooperate, which usually leaves me with a much larger, tender bruise.

After decades of blood draws and IV sticks, I know I’m a phlebotomist’s nightmare. To begin with, I’m petite, so my veins are small. Unless the phlebotomist or nurse is a seasoned expert, he or she almost always uses a butterfly needle instead of a straight needle to draw my blood.

Second, my veins tend to roll or move to the side once a needle is inserted. When this happens, the nurse usually moves the needle around to manipulate the vein back into position.

Nurses have also told me I have “valvy” veins. If the needle hits a valve, it might blow the vein, rendering it unusable.

Finally, I’ve been poked and prodded so many times that most of my “good” veins have scar tissue, so nurses don’t like to use them. I do have some big veins along my wrist and the crooks of my arms. However, because I work on my computer during the 2.5-hour infusion, placing the IV in these areas is problematic because I’m constantly bending my wrists and elbows.

I can’t do anything about the size and condition of my veins. But I have learned some tips to prepare for blood draws and IV sticks, including being hydrated, using warmth, and constricting blood flow.

Hydration

Hydration is the key to plump veins. Being well-hydrated increases the body’s blood volume. With the increased blood flow, veins are less likely to collapse when punctured.

Because of my kidney issues, I usually drink at least 80 ounces of water each day. If I have a blood draw or infusion scheduled, I try to drink more, especially if I’ve exercised heavily the day before.

My nurses advise patients to drink coconut water the day before an infusion. Coconut water is high in electrolytes and has been clinically used as an oral rehydration method in patients with diarrhea. Unfortunately, coconut water is extremely high in potassium, which harms my kidney function, so I can’t drink it.

Warmth

The past few times my nurses have had trouble starting my IV, they’ve placed a heating pad on my arm. Warming the area increases blood flow and causes the veins to dilate. This makes veins more visible and palpable.

I’m beginning to wonder what effect my body temperature has on my veins. I used to be hot-natured, but since my liver transplant, I’ve become sensitive to cold. Before my next infusion, I may need to invest in arm warmers or repurpose some old socks to warm up my arms for the nurses.

Constriction

My third tip, constriction, is one I can’t do myself but can suggest to the nurse or phlebotomist. Tying a latex tourniquet around the arm impedes blood flow, which makes blood accumulate and the vein more visible.

After seeing my bruised arms after an infusion, my mother, who was a registered nurse for more than 50 years, suggested I ask the nurse to use a blood pressure cuff instead of the tourniquet. A cuff inflated to below the patient’s diastolic pressure performs the same function as a tourniquet, but because it’s measurable it can be more accurate.

Tricks for future sticks

While researching the science behind these three tips, I discovered additional advice. One is to do quick, vigorous exercise beforehand to increase arterial blood pressure. This causes the muscle to harden and swell, pushing the veins closer to the surface.

The other hint is to let gravity do the work. I often place my forearm parallel to the floor when I’m waiting for the needle stick. However, several resources suggest dangling the arm to increase blood flow into the forearm.

I have six weeks until my next infusion. With a few more tricks up my sleeve, no pun intended, maybe I won’t leave the infusion clinic feeling like a pincushion.

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