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Massage Today
December, 2015, Vol. 15, Issue 12

TDR to Facilitate Venipuncture

By Linda LePelley, RN, NMT

A few years ago, a client who had been receiving intravenous medications regularly complained that she was dreading her next scheduled infusion. She stated that it was bad enough having to sit there for over an hour and a half, but they routinely needed to stick her several times before accessing a vein, and it hurt. It hurt a lot.

Ever believing that massage can alleviate most pain, I offered to work on her antecubital areas, with the hope and expectation that reducing the overall density of the involved tissues could alleviate the pain from multiple sticks. I performed the treatment based on the principles of Tissue Density Restoration (TDR) massage (See "The Seven Principles of TDR Massage,"  Massage Today, July, 2015.)

Before treatment, the density of the tissues of the antecubital area were elevated, rated at G2 (See "The Tissue Density Grading Scale: A Communication Tool," Massage Today, March, 2014) with slight ridging palpable. After heating the areas and applying the massage, the grade was reduced to G1, with no ridges present. I wasn't disappointed, my client later reported that the entire procedure was painless and I was happily surprised to learn that not only was her nurse able to insert the cannula on the first attempt, but the infusion was completed in 45 minutes.

Since this experience, the occasion to suggest massage to family and clients before routine, expected venipuncture has arisen several times. In each case, whether I administered the treatment or the client did it for themselves, the results have been all positive with no complaints. While these are only a few events, they seem to be repeatable, and are worthy of further investigation. It would not only reduce the pain and anxiety for those being punctured, but if the treatment results in an increase in the rate of infusion, there could also be an increase in the number of patients a facility can treat per day as well. Please note this is not intended for persons who have indwelling ports such as used for dialysis, PICC lines, and the like.

venipuncture - Copyright – Stock Photo / Register Mark The procedure to prepare an arm for venipuncture is as follows:

  • Apply a warm pack to the antecubital area for several minutes, then rest the arm on the warm pack as you work on it.
  • Use a slick massage cream that does not absorb quickly, apply petrissage in a generally circular motion to the target area, taking note of any lumps, bumps, tender spots, or ridges.
  • Continue the petrissage, using as much pressure and movement of the target area as possible without causing pain, for 45 minutes to an hour, during which time you will feel the lumps, bumps and ridges smooth out, become less dense, and they will eventually soften and dissipate.

TDR Massage is very effective, but the time required to achieve results can become tedious, so when teaching clients to do this massage for themselves, suggest they do it while watching a show or visiting with a friend, to prevent their becoming bored. Once both ante-cubital areas have been massaged to a tension-free and malleable state, a monthly maintenance routine should be established. Warming the tissues and giving them a brief massage to ascertain that there are no ridges or increase of density will prevent future difficulty with venipuncture.

My Perspective on Pain

TDR Massage is focused entirely on the real and existing state of the tissues that are in pain. In nursing school, I was taught that pain is whatever the one who is experiencing it says it is. At the time, I thought this meant that we should treat everyone's pain, even those who were just imagining it. In the years since then, I have consistently and repeatedly found that tissues which are in a state of pain are associated with a palpable elevation in their density, referred to as Elevated Tissue Density (ETD). I've found and relieved painfully dense tissues in many dozens of people who were thought by other care providers to be imagining or faking their pain. By focusing on restoring the density to a softened and malleable state, the ETD as well as the pain is resolved.

When discussing pain and massage, it is important that the terms being used are understood by all of the communicants involved. When I say that I can feel another person's pain, I am not expressing my emotional or empathetic response to their distress. I am saying that with my hands, I can palpate, measure, document, and treat an actual and real state or condition that exists within the musculoskeletal tissues. Anyone who wishes to do so can also learn to palpate and distinguish tissue that is in pain from that which is not. This kind of "feeling" is in no way an energetic or intuitive sense, it is an actuality. I make no claim of any special gift, only that I pay attention to small details and question everything. Pain is real, and it is palpable, not only by the person who has it, but also by anyone else with an educated touch.

Click here for previous articles by Linda LePelley, RN, NMT.


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