Getting My Remicade Infusion

So yesterday I had my Remicade infusion, and since some of you had asked about the process I took some pics.  The nurses were a little anxious at first (I guess they thought I might use the pictures to complain or something) but once they saw that I only photographed body parts they were ok.

At 8.40am I had an appointment to see my Rheumatologist.  First the nurses check my blood pressure, weight (which the pharmacy needs to determine the correct dose of Remicade), temperature (to ensure that I don’t have a fever), and pulse.  My blood pressure was raised a little (130/90), but I know that it is because I’m nervous.

I then go and see the doctor, who typically will ask me about my joint pain and general well being.  She will check my throat, listen to my lungs and heart.  She will also check my spots of psoriasis and pitting in my finger/toe nails.  I finished with the doctor about 9.40 am.

After seeing the doctor I will go to the phlebotomy department where they will take my blood.  First they will check to see which veins are good for “jabbing”.  They apply a tournique first, and here is a pic of them checking my left hand:The veins on my right hand looked better (i.e. easier to access) so they moved to that hand.  You may notice the psoriasis on my wrist in line with my watch band. This is the Koebnerization I mentioned yesterday:Once they found a suitable vein they prepared the area by cleaning it with an alcohol swab (which you can see them doing).  After that they stuck the needle in.  I did take a picture of them doing that but it came out all shaky.  Ha – no surprises for that I guess.  However I was really surprised that the insertion of the needle didn’t hurt one bit this time!  This is the first time it has been painless. After the needle was in they withdraw it to leave in place a tiny plastic tube.  They then take some blood samples first to send to the lab:Taking Blood

After the blood is taken they remove the tournique and apply the “heparin lock”.  This is basically a small tube attachment which makes it easy for them to attach IV lines or give intravenous injections:Attaching the “Heparin Lock”

Once the heparin lock is in place they insert some salty water (flush with normal saline) to clear the tube of any blood.  This is because they don’t want any blood to clot in the tube.  If it did then they would have to insert a new tube.  Apparently sometimes they add heparin (an anticoagulant) to the flush, which is where I guess the name “heparin lock” came from.  Here they are flushing the line:The whole process at phlebotomy is over pretty quickly.  These guys do hundreds of blood tests a day I guess, and I am usually in and out in 10 minutes.  After this I am done at phlebotomy and I usually just have a coffee and read the newspaper for an hour – as this is how long it takes for pharmacy to prepare the Remicade and send it to the clinic which is where the administration takes place.  Sometimes the doctor doesn’t want any blood tests done, and in that case I will skip phlebotomy altogether and just go to get my coffee.  Once I get to the clinic the nurses there will insert the heparin lock.

After an hour or so I head to the outpatient clinic where they will administer the Remicade.  This clinic basically comprises a row of la-z-boy type recliners, with curtains between for privacy.   They do have some private rooms too, and did offer me that the first time I went, however I was too bored just staring at the four walls, and preferred to be sitting outside where there was a bit of people traffic I could watch.

Once I arrive at the clinic they take my blood pressure and temperature again.  Then the nurse gives me some Chlorpheniramine.  This is an antihistamine and they give it to me to help prevent an allergic reaction to the Remicade.  They also give me one 500mg pill of acetaminophen.  I have no idea why they give me that.  Here is a pic of the chlorpheniramine waiting to be injected.  There is also a syringe of normal saline which they use to flush the heparin lock following administration of the antihistamine.  For all medications, the nurse always has me check the label before adminstration to ensure that it has my name and date of birth.And here is a picture of the nurse injecting the chlorpheniramine.  Actually I find this to be the worst part of the procedure.  Why? Because a side effect of chlorpheniramine is drowsiness, so beginning about 10 minutes after administration for more than an hour I struggle to stay awake.  I hate it as I usually bring some work with me and want to stay awake for it!From this point on they usually take my blood pressure every 15 minutes or so right through to the end of my Remicade infusion.  After the chlorpheniramine they give me another saline flush through the heparin lock, and then attach a small bottle of saline which will drip through slowly – I’m pretty sure this is just to keep the tubing clear.  Here is the normal saline:I have to wait 30 minutes after administration of the chlorpheniramine before they start the Remicade. Once the 30 minutes is up, they take my blood pressure, get me to check the Remicade label on the bottle (they mix the Remicade with normal saline), and then start the Remicade infusion.  The infusion takes about 2.5 to 3 hours.  Here is a pic of the Remicade – as you can see it doesn’t look that much different from the bottle of normal saline – just a bigger bottle:Once the Remicade has finished, they hook up the normal saline again and let that run for about 5 to 10 minutes.  Enough to ensure that any Remicade in the tubing has gone through into my body I guess.  Here is the final flush via the bottle of normal saline:After that they remove the heparin lock.  I have to stay a further 30 minutes just in case I have some kind of delayed allergic reaction, however they are happy for me to wander around as long as I stay within the hospital, so I typically just head upstairs for another coffee.

Finally here is a picture of me in the recliner, listening to some music while getting my Remicade.  As you can see I’m very relaxed:So that is the process of getting Remicade!  Hope it is useful for someone.

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