My first thought was that this is related to nerves close to the
veins, not directly in the vein wall. Nerves, veins, and arteries are
located very close together. Some patients have a heightened sense of
pain due to their primary or secondary disease processes. Nerve
innervation of the vein wall is largely the autonomic nervous system
in the tunica adventitia and stimulation would lead to a vasovagal
reaction. But this causes vasdiliation, not constriction.
We are seeing nerve damage from infusion therapy and vascular
access in greater numbers now and there is really no good explanation
that I have seen. Reflex sympathetic dystrophy, now called chronic
regional pain syndrome, Type 1 is a life-long nerve condition that is
totally out of proportion to the actual nerve trauma. No one has a
good pathophysiological explanation for this yet. A simple peripheral
venipuncture or small infiltrate could cause this problem is some
patients.
To reduce the pain, it sounds like greater amounts of local
anesthetic is needed before the procedure, but this begs the question
of how do you know which patients will have this reaction. Lynn
At 10:30 PM -0400 10/26/06, Cheryl Kelley wrote:
Gwen,
This is an observation that I never thought about but I have seen. I never really tied the two together until you mentioned it. I have seen the pt. who seems to have more pain than usual and he vasoconstricts easily. Lynn, do you have any rationale for why this would occur?
Cheryl Kelley RN
PICC Nurse and Infusion Consultant
and
PICC Nurse at West Virginia University Hospitals
304-823-3196 or 304-669-3061
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
