March 31, 2010

PICC line in

I am a pretty princess.

Okay, not really. I am gowned and all ready for PICC placement. I was gowned and ready for close to four hours because the doctor was really, really late. However, I can forgive that, as he was super fast and super efficient placing the PICC. It was literally a five minute process by the time he got started.

The problem with processes like this is that while the actual procedure is fairly straightforward and uncomplicated and often quick, there's a lot of BS surrounding it and leading up to it. I had to be at the hospital by 9 for check-in and have my vitals taken and all that. I had to do the full gown thing, even though it's a waste of time taking one's pants off for a PICC line. They also wouldn't let me keep my cellphone either, which proved to be quite unfortunate when the doctor was running late. Next time, I'll make more of a fuss about what is and isn't reasonable for a PICC line procedure.

I had to have blood drawn because apparently the results from my blood draw two days ago hadn't been faxed over to the hospital. And, of course, the staff keyed in on my diabetes right away, so they had to do a blood glucose test (124, a little high). THEN I had a two hour wait while the coagulant test did its thing. (At least, they tell me that's what the wait is for.)

Finally, about 12:30, the doctor arrived and the nurses started to prep me and the local area with all the needed equipment.

I had a guy named Dr. Huntz Liu, a very professional, nice guy about my age. As he was running late, he got right to work. (I noticed he didn't apologize for keeping everybody held up, nor did he take time on pleasantries after the procedure, but scooted off elsewhere.) I did take a moment to explain to him that while I would prefer my left arm be used, it may be difficult due to scarring from previous PICC lines. I do most things needing strength with my right arm, so it is more natural and easier for me to have the PICC-handicapped arm be the left one. I also want to sort of reserve my right arm as scar-free territory for when it is really needed and there's no other options left. I explained all this to him and then allowed that if he had trouble placing the PICC in the left, he had permission to switch to the right arm. I didn't want to be stuck too many times, nor did I want to be there all day for multiple insertion attempts. The doctor suggested we could try placing another IV - a peripheral - and using that to inject contrast so he could visualize my vein better than he can with ultrasound. Hell yeah! And why hasn't that ever been suggested before?

So after getting strapped to the procedure table and all wired up with heart and pulse ox monitors, and having my arm strapped to a board to my left, the nurse quickly placed the peripheral. I was draped and tucked and generally feeling a lot like more major surgery than this really is, but I know it's all precautions against infection.

When everything was truly prepped, the doctor did his thing. I felt two stings of lidocaine and a few seconds later the doc says, "Ok, a little pressure now" and that's literally all I felt as he put the introducer in. (Introducers are big - and they hurt like hell if you're not numbed up.) He must have evaluated the vein w/ the contrast medium (there's a continuous x-ray going on) and knew exactly where he was going, because one stick was all it took. He VERY quickly threaded the catheter in. This I could feel. It is not painful, just uncomfortable and I'm glad he made short work of it. By the point where other practitioners would be starting to feed the catheter in, he'd already pulled the guide wire, verified placement on the x-ray monitors, and was stitching the base to my skin. Less than a minute later, he pulled the sterile drapes off from around the site; the nurses dressed it, including a new little antibiotic pad I haven't seen before, pulled out the peripheral, and I was on my way out of the room and out of the hospital.

This was VERY neatly done. As far as I can tell, no blood spillage; extremely quick; the dressing is about perfect, and I have a lot less of the residual soreness I'm used to feeling.

Still, I'm very tired. And after having had only one cup of coffee all day (after the procedure - can't eat or drink before it), I have a medium sized headache. I'm now waiting for the home nurse to come so I can do my first doses of my antibiotics: meropenem, tobramycin, and vancomycin. She has to add an extension to that little part dangling down in the picture; and somebody needs to be around while I do the vanco. Despite the Benadryl I'm about to take, I will have a reacting, and she'll need to be on hand to ... I don't know, call an ambulance or something if it gets too severe. Wish me luck!

One last thing: I grabbed that coffee and a muffin at the Dunkin Donuts near the hospital, right after I walked out. Having to dose for the carbs, I found a corner for some privacy, but there was someone else already there. He seemed interested. Turns out his little brother has been using insulin for many years. We talked a little about diabetes and diet and then topics turned to the MTA, Bloomberg, and the like. We must have talked like that for half an hour. It was nice, but ended with me excusing myself for a coughing fit.

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