Hallwang Clinic #7 – look ma – no veins! PICC line to the rescue

Pic line

PICC line/central venous line (after removal) with two lumens

Because of a series of high dose IV C infusions, my veins were non-existent or brittle as they hadn’t been flushed with saline after each session of IV C.

I had one or two faithful and hardworking veins which I trotted out whenever I needed blood tests or infusions.  But they were getting tough and bruised.  One of them was also in an awkward position, on the underside of the arm, next to the elbow.  Getting to it required advance yoga practice.

My experiences with IV C had included 5 attempts to find a vein.  So as you can imagine, I wasn’t looking forward to the multiple sharp-and-pointy experiences that awaited me at Hallwang.

I was by no means needle-phobic, but it was not pleasant, and I did not want a repeat of the same.  I knew that there was no way I was going to find 21 willing veins during my stay at Hallwang, so I bravely chose to have a PICC Line, a semi-permanent catheter inserted.

A peripherally inserted central catheter (PICC or PIC line) is a form of intravenous access that can be used for a prolonged period of time.

It is usually inserted in a peripheral vein, such as the arm, and then advanced to a larger vein, until it rests close to the heart.  A PICC line can run from 25 to 60 cm.

PICC line - wikipaedia

photo credit: wikipedia

Inserting a PICC line is done under local anaesthetic, with the guidance of ultrasound.

I hadn’t realised what I was letting myself in for.  Because the veins on my arm were too small, Dr K had to go higher, much higher up – to the chest area, between the collar bone and the first rib, into the sub-clavian vein.

[At this stage, because it wasn’t inserted in the arm, the PICC line became technically a non-skin-tunnelled central venous catheter, and not a PICC-line proper.]

I was told to relax.  Relax?  Relax???  I’m rubbish about pain, and prior to the clinic had never had surgery.  I’d already had a biopsy, and here I was foolishly insisting on having another procedure in the same day.

Dr K is a genius at haematology, but even he had a tough time because of my sad veins and my nervousness.  Each time he tried to insert the needle, the vein would spasm shut!  Eventually, he had to use another vein, and it took two attempts before the central venous line was in.

Centrally-inserted venous line (looks worse than it is)

Centrally-inserted venous line (looks worse than it is)

But it was in, a definite hooray moment!  It felt weirdly intrusive for a bit, and the area was sore for several days, but it would be a real life-saver – I really loved my PICC line/central venous line, and so did the nurses.

The line came with two lumens [top photo] or attachments which allowed for more than one infusion to be given at the same time.  At one time I had four bags of infusions dripping into me.

There were days when I had to have four or five blood samples taken, and it was a piece-of-cake with the line.

Care of the PICC line/central venous line was relatively simple in that I didn’t have to do it myself – the nurses at the clinic took care of that!  The whole area was kept under a waterproof dressing which had to be changed if it got wet.

I even went swimming and to a sauna with the line.  Everyday, the line was flushed with saline before and after infusions, and heparin (a blood thinner) was injected into the line to keep the blood from clotting and blocking the line.

Removal of the line was a breeze.  I was dreading it, and when it came to the actual moment, hardly felt it.

For more information on PICC lines and central venous catheters:

http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Chemotherapy/Linesports/PICCline.aspx

http://en.wikipedia.org/wiki/Peripherally_inserted_central_catheter

http://en.wikipedia.org/wiki/Central_venous_catheter

There are also YouTube videos, but I suggest you don’t watch them if you’re the nervous type, like me, who tends to watch horror movies with her eyes shut.

*****

PICC lines/central venous lines are not exclusive to Hallwang.  They are part of standard-of-care cancer treatment.  What was unusual was that the procedure is done fairly quickly at Hallwang, without any delays, by the chief oncologist Dr Kopic, who is also a haematologist. (This is what you are paying for, very quick response times and one-to-one attention, when you’re at a top German oncology clinic.  It kind of spoils you for when you have to queue for a blood test back home in an NHS clinic)

If you are having treatment that will require multiple blood draws, and multiple infusions, then PICC lines/central venous lines are a godsend.  I didn’t enjoy the insertion process, and flinched and was a bit of a drama queen throughout (I don’t do British stiff upper-lip), but it was relatively fast, and it saved me from many unpleasant encounters with sharp and pointy things.

A number of cancer patients at the clinic had another form of central venous lines called ports, implanted in their chests – but that’s not something I’m familiar with, except that it has to be done under general anaesthetic, costs more than a PICC line insertion, is less obtrusive, but leaves a lot more scarring.  But it can be left in for longer than a PICC line/central venous line.

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