My Diary of IVIG Gamunex-C Infusions

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March 11, 2013 IVIG Infusions BP- 134/87 Wendy is my nurse today. She takes my vitals and gives me my pre-medication of tylenol and benadryl .
IV is set. INR taken. The first bottle of Gamunex is hung at 9am. I should be here 6 1/2 hours.
So far, so good. Feeling alittle tired from the benadryl. May take a nap.
Today went well. So tired. when I got home I ate dinner, went to bed. Slept really well for 2 hours before watching alittle t.v. Then
fell asleep again, exhausted.
March 12, 2013 IVIG 2nd day BP 134/76- good
Realize now I forgot to take my predisone 10 mg. yesterday. That is why I was so tired all day. I had forgotten all my meds for the day at home. My husband brought them to me on this lunch time. But not the predisone. Day progressed well. My iv site was able to be opened and accessed. We wrapped the site last night in an ace bandage covered by a white sock covering with the toe end cut off. The idea was to save the iv site access so we could make it easier to access today. I am such a hard stick so this method is a way around having to have a new iv site started each day.
INR blood work was taken. Convenience of the hospital labs my result were given to me within the hour. My INR was 2.5. PCP called and told me results as well. Instructing me to stay with 6 mg. of coumadin daily and recheck next week.
It is 12 noon and I notice my chin is starting to turn bright red. This is a tell that the benadryl is wearing off. A process of the Gamunex allergic reaction. This also means my pre-medication is wearing off. Since I am here for such a long period of time, they give me a second dose of tylenol and benadryl everyday around noon.
It is time for the second dose of tylenol and benadryl. The afternoon benadryl is given by IV push at the iv site. My nurse Wendy is administering the benadryl slowly thru the iv. and flushes the site with saline solution. Within 5 minutes I felt a burning discomfort and looking down at my arm in amazement. My entire underside of my forearm is a bright red MAPPING of my veins. My veins patterns all over the place like a spider web. The red line mapping pattern is following my veins and continues to make its way up toward my bicep following the pattern of my veins which are now very pronounced. I to monitor my arm in amazement. Realizing this can not be normal, I summoned one of the nurses and she looked at what was happening. She in turn got the attention of 2 other nurses. All three nurses now are hoovering over my arm. Staring and observing the arm. Watching the pronounced redness of the veins in my arm slowly travel upward. Wendy went back to the desk and did some quick research. Mel, the nurse taking care of me today, decided that this is a flash reaction that she has seen happen in chemotherapy patients, but they have never seen something like this with use of benadryl medication. I tell Melody that I am weird. We both laughed. But she gets it. My get it. Anything that is rare or a complication you can be sure that is me you are describing.
Wendy returns with a cold compress. She tells me that this is superficial phlebitis. We can control it by either cold compresses or hot compresses. The cold compress is applied first. After 5 minutes the compress is checked. The area does not seem to be disappearing, but it did stop progressing upward. She feels a warm compress is needed. Wendy returns with a warm compress. Placing the cloth over the red mapping image that is still present on my arm and bicep. She checks the area after 5 minutes and now we do see an improvement. The red mapping is starting to disappate and has stopped climbing up my bicep. Wendy rewarms my compress to reapply and the next time we check on the area the arm is back to normal. The red line vein mapping has subsided completely.
Melody and Wendy make the decision to give the benedryl in a piggy back technique instead of the iv push as in the past. They will dilute the benadryl and administer the medication over a 20 minute infusion along with the Gamunex. This will be tried tomorrow when I come back for my third day of infusions.
My infusions ending at 4p.m. We again wrap the iv site in an ace bandage and white sock. I again went home, had some dinner and I was sleep by 8p.m. I slept well except for getting up at 3am to use the bathroom. I can tell my pain level is already decreased. I am feeling so much better.
March 13, 2013 BP 149/76 Third Day
IV is flushed- Arm IV site looks good. and the saline solution is hung first. The saline solution is hung first so that we are positive the vien is open. Then Wendy hangs the Gamunex solution and the infusion begins.
I awoke with a bit of a nose bleed this morning. I wear a cpap, so I am thinking I just need some hydration with the cpap tonight. I am constantly blowing my nose and seeing red blood. This would not be a problem, but today I am also releasing little clots as well. This scares me alittle. I also have some post nasal drip, so I am not sure what is going on. I continue to need to blow my nose repeatedly. Each time there is a bright red blood discharge with clots. I do not know what to make of this. This continues for about 45 minutes. I reported this to my nurse Melody upon arriving at the infusion center. I will also mention this in follow up with my PCP appointment on Friday.
Hypersensitivity vasculitis-could this be reason for my bright red blood vessel mapping that was all over the underside of my right forearm. was the blood vessels/veins sensitive to the iv push of benadryl?
This is a group of diseases in which various clinical syndromes occur which have inflammation of the small blood vessels, including the small arteries, capillaries and venules, in common. Especially the latter are likely to become involved (venulitis). Although all organs may be involved, manifestations of the skin will dominate the clinical symptoms. The outcome of the disease tends to be positive, as there is an indication of the cause. This can be a drug, a foreign protein or a bacterium. Other immune complexes may also be of significance. It is 1p.m. and I am looking at the mottling design on my arms. I look swollen and when I press on my skin there is edema. I point this out to Melody, my nurse and she is concerned too. I told her upon standing my blood pressure plummets and I am dizzy and short of breath upon movement. We use the pulse oximeter to record a room air of 96 and heart rate of 105. I am also cold and my raynauds is present. Mel takes my blood pressure and it it 128/78, which is good. One minute later I am standing, feeling dizzy and my blood pressure is 110/68. Mel makes notes and decided to give my PCP a call. He will probably want to fax over an order for the lasix medication. Might as well piggy back this medication too. She is also going to tell him of the vasculitis red mapping issue that took place yesterday. I am feeling cold now and reach for one of the heated blankets. My arms are taking on a mottled look. When we press on my skin the white indentation remains for longer than it should. There is definetely an edema of some sort going on.