Because I have done this a few times, and have a sister who has as well, I kind of forget that not everyone knows how home IVs work. I've had several people who seem genuinely curious about the process. So, for those who are interested, and not squeamish, I thought I'd kind of detail what the process is like and how it all works.
First is the insertion of the PICC- a peripherally inserted central catheter. The PICC is a type of semi-permanent IV line so I don't have to have a needle stuck in the back of my hand for two weeks. The doctor this time around, Eugene, also explained that the amount of antibiotics can be too much for the veins to handle, so the catheter allows the medicines to be delivered directly to a very strong artery just outside the heart. The meds are then immediately pumped throughout my body.
The process of inserting the PICC used to be a lot more simple- a nurse would apply some numbing cream, then insert the catheter into my arm. I'd go for an X-ray afterwards to ensure it was in the correct place. Now it's much more complicated (thus the anxiety leading up to it). The last three times I've had a PICC inserted I was in a surgical radiology room where I laid on an X-ray table. The doctor sterilizes my entire upper arm and preps the area then uses an ultrasound machine to find the best vein. Once he decides on the best location, he then injects lidocaine to numb the area (sometimes I wonder if the "bee sting" pain of the numbing injection is really worth it). A tiny incision is made in my skin (2mm), then a wire is pushed in through the incision and into and through the vein. The doctor takes an X-ray to ensure the wire has followed the correct path to my heart. Then he inserts the catheter- a really thin tube, and removes the wire. He finishes up by securing and "dressing" it. Curious what it looks like? Because I have several friends who are squeamish about these things, I thought I'd give you the option to look, or skip it. Click here if you want to see what the insertion site looks like. If you don't want to see an actual picture, here is a good illustration I found on the internet.
The process of inserting the PICC used to be a lot more simple- a nurse would apply some numbing cream, then insert the catheter into my arm. I'd go for an X-ray afterwards to ensure it was in the correct place. Now it's much more complicated (thus the anxiety leading up to it). The last three times I've had a PICC inserted I was in a surgical radiology room where I laid on an X-ray table. The doctor sterilizes my entire upper arm and preps the area then uses an ultrasound machine to find the best vein. Once he decides on the best location, he then injects lidocaine to numb the area (sometimes I wonder if the "bee sting" pain of the numbing injection is really worth it). A tiny incision is made in my skin (2mm), then a wire is pushed in through the incision and into and through the vein. The doctor takes an X-ray to ensure the wire has followed the correct path to my heart. Then he inserts the catheter- a really thin tube, and removes the wire. He finishes up by securing and "dressing" it. Curious what it looks like? Because I have several friends who are squeamish about these things, I thought I'd give you the option to look, or skip it. Click here if you want to see what the insertion site looks like. If you don't want to see an actual picture, here is a good illustration I found on the internet.
Once the PICC is inserted and ready to use, my prescriptions are called in to a home healthcare pharmacy. A nurse comes to my house, takes vitals, then teaches me how to infuse my medications.
In this case I have two antibiotics to take intravenously. Both are to be taken every 8 hours. One of the medications takes (at least) an hour to infuse. The other takes 30 minutes. If you do the math that means at least an hour and a half of medication and six and a half hours between the doses. Funny how those 6.5 hours seem to be quite lengthy during the day, but far too short at night!
When it's time for a dose of medication, I unscrew the cap from my PICC, and twist in a syringe of saline. I inject the saline to clear the line, then I hook up my first "ball". Unlike in the past when I've had poles and hanging bags, home IVs are now usually done in a small ball that is pressurized. The pressure slowly forces the antibiotics out of the ball and into my body. This allows me a lot more freedom as I can put the ball in my pocket and continue with daily life. I even did it at work!
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| Saline |
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| The syringe screws right onto the line |
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| Full/Empty infusion ball |
Once one medication is finished, I switch to the second, screwing it onto the line as before. Once it's fully infused and the ball is deflated, I inject another syringe of saline to clear the line and ensure all of the medication made it through, then I inject a syringe of heparin which helps prevent the blood from clotting in the line and causing blockages.
It's honestly pretty simple and easy, but there are a few things that get bothersome. The lack of sleep, of course, is frustrating. How can a person get well when they can't get a full uninterrupted 8 hours of sleep? I also hate that I have to have Jason help me before and after every shower- the dressing can't get wet so I wear a rubber sleeve designed to cover PICCs and casts over the site. I can't get the sleeve on or off my upper arm by myself.
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| Technically you're supposed to suction the extra air out but the ends are so tight on me I find I don't need to |
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| Stylin' |
I also despise the required weekly dressing changes. The bandages over the PICC line have to be changed weekly in order to clean the area and prevent infection (the line goes directly to my heart after all). I hate having the bandages peeled off. I'm also a wimp when it comes to "boo boos" (ask Jason- any time one of the boys is bleeding I make him take a closer look to see how bad it is. I just can't.) and I hate anyone messing with them. Having someone move it around and rub it with alcohol makes me cringe, even if it doesn't hurt. I joked with my nurse this time, as she changed the dressing, that it's funny that I have given birth naturally, but I can't handle the small amount of pain that comes with the dressing changes. She was incredulous, so I told her, "it's different! There's a prize at the end when you're in labor. There is no prize here." Having had two children herself, and having chosen an epidural, she outright disagreed with me. :P
For the time in between doses, I usually put a "sleeve" of some sort over the tubes to keep them from dangling around and getting caught on things. I usually use a nylon-type stocking with the toe cut out, but I've also used an athletic neoprene sleeve of Jason's which works nicely (Jason says Nike calls them "shooting sleeves." You see basketball players wear them.).
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| June 2008 (when I had my previous sinus surgery) Not sure if that margarita would have been recommended or not... |
The actual placement of the PICC does vary from time to time. Lately it's been a lot higher on my upper inner-arm whereas in the photo above it was closer to the crook of my elbow.
It may not be fun, but I'm thankful to be able to stay at home with my family, away from the hospital and germs. Jason has been ensuring I still get lots of rest, and having Tuesday through Friday off this week due to weather certainly helped with that as well!
I wondered about how the IV antibiotics would mesh with going to work. Are your sinuses feeling any better?
ReplyDeleteThey are, actually, though I'm still "looking forward" to the surgery to really clean them out.
DeleteI have to disagree about the dressing changes. I desperately look forward to the 5 minutes or so of letting the skin breathe, and be cleansed and soothed a bit. It's interesting to see how every home care company does things differently though. I have had a couple of IV antibiotics that just came in a giant syringe that I infused over about 15 minutes. And for me, the pressurized ball ones come with a hard plastic baby bottle around it, I guess to prevent you from squeezing it accidentally (or purposely if you're in a rush).
ReplyDeleteYeah, I've been curious if the process is similar for you or not. That's interesting that your balls are in a hard bottle. If I remember correctly I was told you can't really squeeze the medicine out any faster because the balloon is pretty thick and because the tubing kind of controls it, but even so, being the goody two-shoes I am, I get freaked out if I keep it in a tight-jeans pocket. Although I have sort of tried to squeeze it at the end when it's taken far longer than it should and there's a tiny amount left that doesn't seem to be going anywhere... but I usually gently squeeze once or twice then either decide to give up and take it off, or set a timer for another 5 minutes.
DeleteAnd you're right, there is an element of the dressing change that I do enjoy. I find the skin under the dressing is always itchy and the pulling of the bandages as they're removed sort of relieves that. I also enjoy the "fresh" feeling of a new dressing, but I'm usually wearing my shoulders as earrings during the whole process because I'm freaked out.