A PICC Line…

This – a peripherally inserted central catheter – is what was offered to me in hospital, when they ran out of useable veins for i-v administration.  As you can see here, on the MacMillan website, this is not a fun procedure. Then, in hospital, fun is at a premium anyway!

Not only did the very idea send my newly-acquired needle phobia (the reason for which I’ve explained in an  earlier post ), into overdrive, but I seriously questioned the possibility  that this might be screwed up big-time, given that they’d already trashed every easily-accessible vein through a mixture of clumsiness and plain, old-fashioned, stupidity. For example, before and after an i-v is connected to a cannula, it has to be flushed with saline solution. This is supposed to be painless but, for me, it’s excruciatingly painful and, on several occasions, was responsible for the vein blowing out/blocking. Nobody – repeat NOBODY – gave the tiniest shit about finding out what the hell was going on to cause a routine procedure to go so badly wrong. The attitude was “This isn’t a painful procedure, therefore you can’t be hurting.” Well, hey, I fucking was!

One nurse, clearly the proud possessor of a 20Watt intellect, tried to tell me that what I was feeling was cold, as the flushing saline was kept in the fridge. Er, no. I can actually tell the difference between cold – hell, the i-v bags were in the same fridge, and all I felt was a chill from them – and severe pain!

I didn’t, as far as I can recall – though memory is hazy as I was pretty much out of it at that point – actually refuse, I merely expressed my doubts that people who had fucked up veins they could actually see could safely insert a couple of feet of catheter deep into my body, especially when they couldn’t even get a needle in to draw a blood sample.

The issue wasn’t pressed, and wasn’t raised again, from which I assume it wasn’t actually vital in the first place.

As you can see from this image, drugs are effectively injected into the heart and – this occurred to me much later – I have no idea what effect, if any, this would have on my already damaged aortic valve.

An i-v by this route would certainly raise the pressure within the right atrium and ventricle (delivery pressure has to be greater than the pressure within the heart or it simply won’t work), but whether this would normalise on its trip through the lungs before getting to my aortic valve as it exits the left ventricle I have no idea. Logic suggests it probably would, and this isn’t really an issue, but I’d prefer to know for sure.

Anyway, for now, at least, the question is academic, as unless my life absolutely depends on it there will be no i-vs in my future, and sure as hell no PICC line either.

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9 thoughts on “A PICC Line…

  1. I had a PICC line when I was on chemo and it was fine while it worked. Even that blocked up and I ended up on Fragmin injections incase of blood clots. All but one tiny vein is blocked now on my arms so I feel your pain. The most annoying thing is that not one of the medical staff will listen to what I tell them regarding my veins and insist on trying to find one themselves.

    • Yep – that sounds all too familiar!

      And that was the last thing I wanted – the PICC line getting blocked and throwing off clots so close to my heart – quick way to a pulmonary embolism.

  2. It’s often so difficult for us to make those medical ‘professionals’ understand that what we say is REAL – Good for you for sticking to your guns xx

    • Oh, I think – especially when it comes to consultants and their teams – that they understand all too well, but by refusing to acknowledge that, for argument’s sake, flushing an i-v causes terrible pain (and I’m not exaggerating), and/or blows out the vein (and I accept that this might well be due to a problem with my veins and/or my blood, but it’s still a problem), and simply blaming an “awkward patient” they save themselves a lot of work.

      It is, however, a disgracefully unprofessional attitude and one I encounter repeatedly. And if I do, then others, less bolshie (or, I suspect, less lucky), than I am, must surely be dying as a result. Which, of course, they are
      https://ronsrants.wordpress.com/2013/12/10/lack-of-i-v-expertise-puts-patients-at-risk/

      There is a scar on my arm, still visible after a month, where a ham-fisted staff nurse quite literally blew a cannula out of my arm, the plastic moulding ploughing up the skin and the the pressure from the business end punching a hole through the vein wall and out into the open air**. And these clowns wonder why I get so bloody angry!

      Worryingly, that injury bled only for a few seconds (as do cuts, even bad ones, I occasionally get at home), which suggests I actually do have a problem with clotting. Has it been investigated? Guess!

  3. I’ve experienced this with saline flushes in normal cannulas. I argued with them about it hurting and got a similar response to you – several times. I suggested they look at my hand/arm/leg/foot/big toe which was often swelling visibly around the cannula. The saline wasn’t only going into the vein, it was leaking. Extravasation hurts like billy-o whatever the substance. My veins have a habit of collapsing as the needle goes in, thus, the point of the needle shoots through the other side of the vein, so you have a cannulated and leaking vein. Great!

    Hickman lines that I mentioned the other day are much less prone to clots forming in them. The Macmillan diagram shows the PICC going straight into the heart, as I had it explained to me, it stops short of entering the heart by about an inch or two (depends who fits it)

    Hickman Lines have to be put in by a doctor. PICCs can be inserted by a specialist nurse. Poitioning is checked with a couple of x rays.

    I’ve seen a few patients have problems with the PICC as rubber gloves tend to stick to them when the nurse is doing line care and the sticking can pull the line, messing it up big time and causing the patient a lot of pain. All avoided with a Hickman as you can do line care yourself.

    Hickman lines have a cuff a couple of inches higher than the entrance hole, this cuff is rough coated and allows the cuff to grow in to the flesh inside, so it’s secure and will not pull out. When the line is fitted, a butterfly stitch clip is placed at the hole and the line is attached by two stitches to the clip and the skin. After ten to fourteen days the stitches can be clipped and the butterfly removed.

    Removal of the Hickman happens with lots of local anaesthetic. An incision is made over the cuff and it is loosened with small cuts, this can be fiddly and take a while, then it is pulled out smoothly. Mine was painless and took about an hour. Two stitches are put in for ten days so the incision can heal.

    I was quite sad when they took my Hickman out. When you go from having 53 fruitless, painful needle sticks a day, your veins collapsing over the needle when it goes in to having none of those things happen, it’s both a joy and a relief.

    The other option, is a Portacath. I wanted one of these but having looked into it in some detail and then found out my trust wasn’t funding them (it is now, they cost about a grand to do) I went with a Hickman.

    The Portacath still means needles, still needs regular care and flushing and it unfortunately is about the same as a PICC where clots are concerned. Recovery from the installation can be painful as the bruising around the site can be quite strong.

    • Hi Lucy,

      Thanks for the info, but I think I’ll go with my current plan – no i-vs permitted unless my life actually depends on it, and there’s no oral alternative. What you describe in your first para is exactly what happened to me – every goddamned time! Yet my file clearly says that no-one other than experts from Phlebotomy – not nurses, not doctors, nobody – is allowed to stick anything in my veins, so fragile are they. But, of course, nobody ever reads files!

      It has to be said, though, that until March-April this year, when I was in hospital for 6 weeks, my veins were perfectly fine until the ham-fisted oafs there buggered them all.

      53 needle sticks in a day? I’d have tossed the buggers out long before that. I did, in fact, and now everyone gets one attempt at drawing blood – and that’s one clean stick, not furtling around for five minutes with the needle in my arm up to the plastic!

      And I noticed, both in March-April and last time, that when I started to lose my temper with all the cack-handed fumbling and stabbing, they’d send for a junior doctor who was absolutely gorgeous (they seemed to have an endless supply of stunning young docs!), presumably in the hope she wouldn’t get yelled at or thrown out. Wrong on both counts. Might have worked with a youngster, not with a cynical old fart like me!

      On one occasion, though, an old bloke – must have been close to my age – turned up to take blood. Looked at my veins, pulled a face, and rummaged in his kit until he came up with an extremely fine, and very short, blue cannula. One stick, in a vein I could barely see, and got a veritable fountain of blood, so with the right needle, and the right technique, it can still be done. Of course, I never saw him again, and nobody else managed to get even a drop! I did notice, though, that everyone else opted for bigger cannulae or plain needles (a lot seemed to favour cannulae for drawing blood – no idea why).

  4. During the 56 needles sticks a day period of my life, I was too ill to fight the buggers off Ron and compared to the pain of the condition I had, the sticks were low on the pain scale. However, they were a relentless, horrible and unnecessary addition to the whole business and made it harder to recover as the drugs couldn’t get into me in enough quantity or for long enough. Various docs chattered about putting some kind of multi-ported device in my neck (jugular I guess) to get around this venous collapsio issue. But, because of so much faffing about, inability to diagnose properly and delays to urgent scans by the time there was theatre space to put the port in, I was too unwell to have it done.

    I found that the phelbotomists had the best hit rate and often used the long thin cannula to get it. I made the mistake of telling one nurse this and she immediately got the hump and told me that phlebotomists couldn’t get a venflon flowing as they weren’t trained and anyone could take blood (apart from her clearly) She said all this as my big toe was swelling up fast with neat Tazocin flowing out of the vein into the toe. I had to interrupt her festival of taking it personally by pointing to my toe. She ignored it, so began the six times daily ritual of waiting until the useless vein stabber had gone, pressing the buzzer and pointing to drip that had stopped flowing, then pointing to whatever poor body part was filling up due to extravasation.

    I don’t blame you putting a ban on IV unless it’s life saving. Regarding them never reading the notes, my GP suggested that I keep a laminated statement on me when in hospital to wave about in front of these staff and ask (make) them to read it. Everything is in my notes about me, but no one reads the notes. I haven’t had to do this yet, but I wonder why they should take something written more seriously than me telling them in plain language I do not know. Maybe it’s part of training for doctors and nurses these days to consider all patients to be ignorant, uneducated, dumb and unable to accurately report pain?

    • Sadly, for most patients, your final para is all too true – they can be all those things, in my experience.

      Often the only source of entertainment is listening to conversations between doctors and patients on the bays, and the level of patient ignorance is terrifying.

      One guy, told he might well have HIV, spent the afternoon telling his visitors he had hives!

      • In 1975 I had a gastroscopy. That was supposed to come with an i-v shot of Valium, but the fumble-fingered oaf went straight out the back of the vein and pumped my hand full of the tranq. It did absolutely nothing for the gastroscopy (except put me off ever having another), but I was stoned for a week until the Valium finally leaked away, or metabolised.

        It also set the scene for all the i-vs that were, unknown to me, waiting in my future. Back in April, for a colonoscopy, they couldn’t get a cannula in for the sedative and contrast medium (this was CT-scan assissted), so I got neither, and wasn’t that fun!

        Admitted unconscious in August, I resurfaced two days later (I think – it might have been longer), to find my hands and arms a very fetching shade of purple, so extensive it looked like a Yakuza tattoo, and dotted with multiple perforations from, I was later told, i-v antibiotics, though I have no idea how successful, or otherwise, they were – just that there were a hell of a lot of holes in me which, based on recent events, suggests multiple failures.

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