| May 5, 2002 Update
As a very experienced user of all types of insulting devices being
stuck into my body, this latest strategy is by far the worst. Since
I had so much trouble with catheters and PICC lines, they have decided
that I will have a peripheral IV (Same type that most people get when they
go into the hospital). So far it has been changed about fie times
and each time requires multiple pokes since my veins are collapsing.
I fully understand why this has to be, but it still sucks. My arms
look like those of a full fledged junkie.
February 28, 2002 Update
Hohn catheters SUCK (imho)
My Hohn catheter lasted about a week and when it came out we discovered
that it had barely enough tubing to make it from the insertion point to my
heart. I'm not sure if it was a botched installation or the device
itself but I would certainly question anyone who wanted to stick one of
those puppies in again.
I am back to a "new type" of PICC line according to the nurse
practicioner who put it in. She had a great time poking around
trying to get it inserted. My arm looks like a punching bag. I
feel like a much abused guinea pig. This is now my fourth catheter
in a little over a year.
Original monologue follows:
I have now been the proud recipient of three types of
catheters so I can speak from practical experience and hopefully warn some of you about pluses/minuses and dos and don'ts -
So here is my monologue on the insertion, care of and dangers associated with IV
catheters. Start by reading the link below:
http://eduserv.hscer.washington.edu/pharmacy/pharm560/6thweek/ivcath.pdf
My first experience was with the Hickman Long Term Triple Lumen Tunneled Catheter - Hickman was the
guy who invented this little gem and triple lumen refers to the number of tubes ultimately available for plugging in to. A lot like plumbing - Hot, Cold and Warm with
separate "faucets" for each.
This was installed via a surgical procedure in February of 2001 and lasted for about 8 months before becoming infected. This is by far the most painful and invasive but it did last me a long time and helped avoid numerous butchered IV insertions. (My arms had become black and blue from all the needle pokes.)
They begin by providing local anesthetic (lydocaine) and then make two relatively small cuts (one in your neck just above the collar bone and the other in your chest. They then "fish" a wire down through your vein and directly into the left atrium of your heart.
This is not as scary as it sounds, but I would have appreciated knowing what to expect before the procedure. They then follow the wire with the plastic tubing which becomes the permanent IV tube. Finally they "tunnel" down from the insertion point in your neck to a permanent mounting place on your chest, attach the claves (little blue connectors which provide a heparin lock to prevent leakage and little plastic clamps which are a further safeguard.)
The whole procedure took about an hour from start to finish and if I were to have this done again, I would opt for "real" anesthesia rather than the local. It was not a pleasant experience. I had some rather annoying pain for a couple of days afterwards and then it became like an old friend.
I "flushed the ports" on a daily basis with the 10 cc's of saline. This procedure keeps the lines "patent" or able to draw back and forth. I also had to change the tagaderm (clear vinyl patch) dressing on a regular basis. After several months, the stitching used to secure the catheter to my chest became very irritable and ultimately became so infected that I landed in the hospital with a sepsis (blood) infection that caused rigors (shaking), severe chills and a fever of over 105 degrees.
This was definitely no fun and landed me in the hospital for about a week. As a result, my
Hickman was removed (had to also be done by a surgeon but was less painful then the insertion and was done in my room rather than in a surgical area.)
I then had a Peripherally Inserted Central Catheter (PICC) installed in the fleshy part of my left arm just below the elbow. This was by far the least painful but also the most useless device. If they suggest a PICC, run the other direction. Mine only lasted about two months, was constantly in the way and ultimately pulled completely out.
In fairness to the PICC, my "statlock" got wet shortly after the insertion and none of the people who looked at the line knew enough to replace the statlock (a very sticky butterfly type bandage that locks the line in place on your arm) I subsequently learned (while having my Hohn installed) that immediate replacement of the statlock may have prevented the line from pulling out.
My latest experience is with a "semi-permanent" device called a Hohn Catheter (again name dfor the inventor). Hohn gets a B+ so far. The procedure was performed by a radiologist and was similar to the Hickman experience but less painful. It only requires the top insertion point near the collar bone and does not normally require suturing. (The doctor made the decision at the end depending on how well the insertion went). In may case, they decided the statlock would suffice.
I have virtually no experience with this device yet, and except for the fact that it is more exposed than the other two (looks like a Frankenstein insertion device hanging out of my neck) I think I will probably like this one the best.
Closing comments - be very careful in the first few days to not get the "site" (insertion point) wet and then try to keep it covered with saran wrap or a "baggie" when you shower. Moisture under the bandage is bad news! If it gets wet, change it immediately. I'm pretty sure that I contributed to my sepsis experience by letting mine get wet (got careless after awhile). Also be sure that you or anyone who changes the dressing thoroughly (20-30 second scrub) washes their hands and wears gloves. My wife (RN) tells me that the gunk under your finger nails is the number one cause of sepsis infections.
Here ends the monologue - be sure to check out the link above and feel free to email me with questions. I am now a self appointed expert on IV catheters! Also check my website at http://aplasticcentral for research information, stories of other patients and even some good music.
Bruce Lande
SAA 1/9/01 2X ATG no success, Cytoxan scheduled for April 2002
sales@aebiz.com
http://aplasticcentral.com
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