The wonders of the Zofran Pump

This is my 3rd pregnancy, with all of them including this one I had severe nausea with some vomiting. This time around seems to be worse then the other two. My 2nd pregnancy I only gained 11lbs total during the entire pregnancy and my first child was even less. This time around the nausea has been way more severe and lasted longer into the day. In the past 2 pregnancies the nausea would go away late evening and I could at least eat. With my daughter (2nd) I was able to go about a week or so between really bad days with vomiting. This one, not so much. I would be lucky to have 1 good day a week, for me the vomiting wasn't as often as I've read other people with a diagnoses of Hyperemesis has had but the nausea was enough to keep me from eating and drinking fluids. I wanted to blog this in hopes that if someone was looking for info on the Zofran pump that this blog would put some minds at ease.

Like most people in this Internet age when my Dr recommended the Zofran Pump I came right home and googled it. I was in the process of looking through websites when the nurse from Alere called me to get the process started. Not gonna lie, what I found on my searches did more scaring me then putting my mind at ease. Even though the nurse said that the needle wasn't very big and you barely feel it the pictures I found were not so convincing, I think the needles looked larger then they really were because there was nothing in the picture to compare it with. I will be posting pictures of everything as well. So here has been MY experience with the Zofran pump.

Before the pump came into the picture I was taking 3 different medications, an oral zofran, dicglis, and compazine. The dicglis is a combo of unisom/vit b6 and benidryl, it was developed FOR pregnancy related nausea/vomiting. The directions to start were to take 2 at bedtime and if after a couple of days the nausea was still lingering to slowly increase the dosage to 4 pills a day. 1 in the AM, 1 in the afternoon and 2 at bedtime. While I noticed a decrease I was still having severe nausea with vomiting days. The Zofran was "as needed" 1 pill every 8hrs, same with the compazine. I ended up alternating between those two every 4hrs (I was told I could do that) while taking the full 4 pills of dicglis a day. The down side besides the fact that even taking 8-9 pills a day JUST for the nausea and it wasn't controlled enough was the fact it made me VERY VERY Sleepy..... We're talking I could almost fall asleep sitting in a chair and I don't fall asleep easily. It made staying home alone with my 3yr old (boy) and 2yr old (daughter) very difficult. Most evenings once my husband got home was spent with me either laying on the couch in a sleepy haze or even giving up the fight and going to bed leaving the family alone which I hated to do. After loosing about 9lbs in a month and my confiding in my Dr that my nausea was still not controlled she recommended the Zofran pump.

I LOVE this Dr, she is quick to suggest something for the nausea and has tried many things to help, when she told me about the pump I was a little hesitant. I mean come on a pump sounds so scary! Maybe that is because my father is diabetic and he is on an insulin pump so I already had a clue where this thing was attaching too! So I started asking questions, now I don't know if my Dr was just trying to make me feel better or if she really doesn't know the specs on it but she insisted NO NEEDLES! Yet she said "It just kinda sticks there" I knew better and the thought of stabbing myself in my belly well it was not a pleasant idea for someone who HATES needles. She also recommended home hydration therapy because I mentioned I suspected I was becoming dehydrated. We ended up NOT going that route due to the fact I would be hooked up to an IV bag for possibly up to 3 days and well a large needle in the arm alone with 2 toddlers just doesn't seem wise to me. Not to mention my veins tend to kick an IV needle out after a few hours on it's own. I opted to go to the hospital for an IV treatment and spent some good quality time with my best friend who was kind enough to drive me and stay with me for the 6hrs I was there.

I will admit here, I was SO nervous about the pump that I delayed a WEEK! The nurses at Alere actually gave up trying to get me to schedule and had canceled the order after telling my Dr's office I wasn't scheduling it. To be fair I was hoping the 3rd medication would kick in and had told them I wanted to wait a week. Well since the 3 medications were not helping enough I decided to give it a try. I called up Alere at 4pm on a FRIDAY.... I wasn't expecting to get scheduled till at LEAST Monday, well the scheduler said "Let me check with the nurse but we MIGHT be able to get you in tonight, if not tomorrow some time" I was floored! Ok so not ready emotionally! Which was probably a good thing. The nurse had to order the medications and she called and said she would be here around 8:30pm, perfect timing for getting the kiddo's to bed and having peace while doing it. The nurse shows up with a BUNCH of stuff..... She informs me that because it takes a few days for the full effects of the medication to get into my system they like to start off with a shot (in the butt!!) of Zofran to help out. I wasn't expecting that, I mean come on. I barely know you for 5min and you want me to drop my drawers with my husband looking on at that??? Ok so it wasn't so bad, just more of rolling the waist band down a little but you know the feeling. So she gives me the shot which didn't hurt..... Till like 10min later when the site starts burning which all in all I've had worse shots in the area then that.

We go over the whole process, which I will include a summary of with the pictures. She pulls out this HUGE book (will post pictures) I think it will tell me EVERYTHING I need to know about my pump and then some. We went through a lot of paper work, they even gave me a helpful holiday safety sheet including toys not safe for infants/toddlers since it's around the holidays. How thoughtful? I have not even glanced at that sheet cause you know I'm in expert in parenting..... (HA).

Finally the time came to get hooked up *deep breath*. The nurse starts going over the pump and how to load the medication syringe etc.

The pump with the syringe attached and in use.

 Finally comes the needle prick, before we get into that let me explain how this pump works. The pump is while not huge but not tiny sits in a pouch, I like to wear it around my waist during the day like a fanny pack. I would say its about the size of a large TV/Cable remote control.

I wear a long shirt and often a sweater and cover it up so the kids don't notice it and want to pull on it. The medication is loaded in a syringe hooked to the pump, the dosage is set by the nurses. At this time I'm getting 0.420ml I believe it's an hour, I am allowed 2 "demand" doses a day which increase the medication to a full 1.00 ml an hour (pretty much it pumps the the dosage amount every 12min instead of every hour till it hits the 1.00 ml then goes back to the normal dosage once an hour. (Actually I believe its some what continuous but comes out to 0.420ml every hour). *edit* I am now getting 0.500ml/hr now. The syringe is loaded with 10ml so mine lasts me between 20-22hrs or so. Out of the syringe comes a very small tube (catheter) which goes into your belly. It is very small, the needle is only used to set the catheter initially and is removed once set. The needle is used to guide the catheter into place in the fatty part of your tummy which if your like me you have plenty. One of the plus sides of um being a plus size..... Like how I did that there?

Syringe attached to the tube and catheter.

The tube & the catheter separated from the syringe. The catheter (round piece with brown tape around it) is flexible and is what stays in your belly after the needle is removed. The needle is actually originally INSIDE the catheter and the removed leaving just the catheter.

So you connect the syringe to the pump, the catheter to the syringe and your ready for the needle. Of course you swab your area, nurse recommends pinching up a large amount of fat to make it easier. At this point the needle is not connected to the catheter.

Needle with the clear hand grips around it, the other one is the catheter with the tape that is waterproof and attaches to your belly.

 

It will be, it has a small catheter that is left inside and you connect the two once it's set.

The needle and catheter together. The swab the picture to show size comparison.

So the nurse directs me to take this needle and going straight in she says it's normally easier and less painful to do it really quick.

Back of the needle, the middle plastic part is to hold on to in order to insert, the two tabs on the outside you pinch to remove the needle from the catheter.

 
So she starts to count me down, 1....2.... STAB it's in, no hesitation on my part (which surprises even me). She kinda blinks, looks at me as I smile and go "hey that didn't hurt!" she kinda blinks at me a couple of times and goes "wow, you did that REALLY well". I think even my husband was surprised. So really, if you get nothing from this post get this, it really does not hurt! I have since changed the site once and I felt it even less the 2nd time. I could feel a small prick in my skin, almost like a zit popping but that was it. You can kind of feel the needle while it's in especially if you push on it like I did by mistake the 2nd time around but once you take the needle out which is as soon as you get the catheter set your good. Surrounding the catheter to hold it in place is a round sticky water proof tape that is heat activated. Once you set the needle and catheter you rub the tape around and around she said for about 15 seconds to make sure it's sealed, then you take the needle out snap the tubing from the syringe to the catheter and start up your machine! That's it your done and ready to feel better!

So here were some of my fears both before and after I had read things online about the pump.

1. Duh the needle, I mean who likes those things?
Conclusion: It doesn't hurt, you barely feel it and if it makes me feel better it's worth the stick every 48hrs or so. Which I forgot to mention you change the infusion site as directed (in my case no more then 48hrs) to avoid irritating the site to much. Which brings me to number 2.

2. I had read and seen online where people get these really angry red welts... One picture I saw the lady had a ring of welts all around her belly button from her infusion sites! Not gonna lie, looks/sounds scary!
Conclusion: So far I have had minimal soreness at the infusion site. That could be cause I'm on a lower dose at the moment but they told me I could change the site as often as I needed to if it starts to become to sore. The infusion site really was only sore when I would engage those abdominal muscles in that area (sitting up from laying down etc). The area after removing the catheter is barely red and not as sore once removing it and I expect that to be gone in a day or two. I have since moved my infusion site a tad higher, I think I will try and maintain a little lower site from now on, this one seems more sore and is not in as much of a fatty area. But still is not enough to make me want to stop the pump.

3. My kids (again 2 and 3) who are still very much (especially the 2yr old) clingy and wanting to sit in my lap through out the day. My concern is they would pull on me/machine and possibly pull the catheter our or cause me pain or both.
Conclusion: I've had the pump in a full 2 days now and they have minimal interest in the thing, most of the time I wear it around my waist under a shirt or two. I tuck the excess tubing in my pants pocket to avoid something dangling to tempt them. There have been a few times I've had it slung on my shoulder instead (like right before bed) and they have seen it. Both kids when they were like "oohhhh whats that?" I just explained that it gives Mommy medicine and they shouldn't touch it because it's giving mommy a shot. After that they tend to leave it alone. They know mommy has not been feeling good so I think they have just kinda took that as part of making mommy feel better and its best to leave it alone.

4. Sleeping with the pump would be uncomfortable and keep me awake.
Conclusion: The only real complaint about it is that it IS attached. I have a pregnancy body pillow, when I'm laying on that side (right side) it's in the middle of the bed and I just slide the machine under the pillow. When I roll over to my left side (I often start our on my right side) I grab the machine and take it with me as I roll and place it on the bedside table. I almost ALWAYS wake up to roll over and often times by the time I'm ready to roll back to the right side I need to get up and pee first so I just repeat the process. I actually don't really feel the site even if I lay half on my stomach.

5. The fear of the un-known.
Conclusion: You never know till you try.

So my final thoughts on this machine (parts other blogs have left out) is that I am so glad I got over my fear and did this. While at this point very early on the nausea is not 100% it is about 1000% better and I'm sure over the course of the next few days they will adjust my dosage to help with that. This pump is nothing to be scared of!

All the new supplies needed to get started. The needle/catheter and tube in the package , the full syringe and a swab.

Since this post has gotten so long as it is, I will post another post regarding my daily routine with the pump. So stay tuned! If you have stumbled across this post in search for info or to calm to nerves regarding this treatment if you are as miserable as I am and looking for ways to avoid this pump please at least meet with the nurses and try it! If you can't stand it you can discontinue the use! I wish I hadn't waited a week, I am really glad I have this pump as I have felt better in the last 2 days then I have since before I found out I was pregnant. I have been eating almost normally and drinking fluids a lot more which has meant no more hydration therapy needed! At least give the wonderful nurses at Alere (who REALLY know what they are doing) a chance to convince you and bring it all out to your house.

Since I wanted to take my time and take pictures, the pictures of the open supplies (syringe, needle, catheter and tubing) were all of used supplies that I was about to trash. I forgot to take a picture of my "bio hazard" container for the needles. Basically they provide you with a sticker and instruct you to use a hard plastic container with a twist on lid. We happened to have an empty animal crackers from Sam's club container still and figured that should be good enough. They also recommended a used plastic Gatorade bottle. The needle goes in the container and the other stuff in the trash. Probably not recommend to use an old needle like I did but I was careful. :)