Subcut issue

[stacey]

I have posted the below on facebook on the XLA page but i thought i would post it here aswell to see if anyone not on facebook may have any thoughts:



Hi, a strange question for you. My son(8) had his Subcut 15ml Hizentra yesterday and about 15mins in he said his leg was wet, so I checked and the medication was running down his leg, i checked that the needle was fully in and it was so I presumed that the therastick must be the problem. I removed it and changed it to a different one with a different batch number just in case. About 5 minutes in again the medication was running down his leg and needle was fully in. So we changed again (different batch number again) this time asking hubby to put it into him just for peace of mind that it wasn't something I was doing(after 7 years I hoped not). 5 mins later it was going down his leg again, so we removed it and will give him a top up this week as 7mls was left in syringe. The thing that has baffled me is that it actually looked like it was going into his leg and then the medication was spilling back out from where the needle was in his leg. The lump he gets after his treatment on his leg also felt very strange, it was very hard and felt plasticy to the touch and had lots of dimples in it. It has also bruised quite a lot this morning, which could be down to changing needle 3 times but we have had to change the needle before when he's pulled it out by accident and it's never bruised. I double checked the therasticks afterwards and they looked fine, I even ran some water through them and they didn't leak. Anyone ever experienced this, as in 7 years of doing his Subcut I've never experienced this before.

[s162216]

Hi stacey,

I don't do SCIG so I can't really comment on it, but I do have a subcutaneous insulin pump which works in a very similar fashion (I always have it connected to me and carry it around in my pocket). It sounds to me like the subcutaneous tissue at the needle site had absorbed as much as it could (as obviously it takes a while for it to be absorbed into the bloodstream - having a pharmacology degree can be useful sometimes like here!), so obviously then it would take the path of least resistance (i.e back out of the needle site) and leak out. The lump sounds to me like a good indicator that that may have happened as I get a similar result if I infuse a large amount of insulin quickly, they usually go down in a couple of days.

Was the needle site particularly near a bone or area of muscle? Obviously there will be less subcutaneous fat around those areas which decreases the amount that the tissue can absorb at once. You might want to give your immunology specialist nurse a call to check that everythings going o.k if it happens again.

Hope you find this helpful,

Sam

[john]

Hi Stacey,
I have used Hizentra (90ml per week) for almost a year after many years of IV, and this has happened to me ONCE.
I always infuse into my belly, and this one time the other three sites worked perfectly, but the site that leaked started doing so as soon as I took the needle out. The sticking plaster had no effect on the leakage, and I reckon the whole amount for that site came out!
I told the nurses at the clinic and they said it does happen occasionally, but it's quite unusual. The reason, as Sam says, was probably a chance siting where the subcutaneous fat wasn't available to absorb the Ig.
In my case it was a quarter of the weeks dose that was lost, but because I maintain good levels i didn't bother to do anything about correcting for the loss, but in your son's case I would go by the nurses recommendation.
Hope he's keeping well, it's very tough on the little ones to have to have all this!

[marksmom]

Hi Stacey,
My son has been on subq for about 7 years...we have had some leaking before but nothing quite as significant as you describe. I would contact your doctor/nurse/pharmacist as I know that when Mark had issues with it, they adjusted the needle size and that stopped the problem. As they grow, they need a larger needle size to reach the subQ tissue (as I understand the doc's explanation, anyway).
Best wishes!!
Rachel

[john]

Hi again Stacey, I didn't realise it was YOU till I had a quick peek at your profile!!
Is it really seven years since diagnosis for your little boy? I hate how time is just flying away!
Hope all is well with you and Steve, and you too Rachel, it's wonderful to see the old gang speaking together again!!

[stacey]

Hi John, we are all as well as can be, hope your doing ok. I spoke to Xander's immunology nurse who said it could just be a one off or that it's the needles being too small or it was the pump, so she wants us to have a think about changing pump and needles as the pump he is on(chrono) is for little kids, she said he should really now be on the freedom 60 with slightly longer needles, he's on 8mm and she said going to either 9 or 10mm ones.

The site the needle went into was his right thigh and we've always used his thighs as he's too skinny to use his stomach.

Thanks for all your replies it really helps to know that I wasn't imagining it coming out of the needle site.

Stacey