Procedures- Tunnelled, Central Venous Catheter- Hickman Line

As already mentioned I had my Hickman line inserted on Friday, it wasn’t a lengthy procedure or in fact too painful, but it has made life in terms of blood samples and injections much more comfortable and convenient.

What is it?

The main benefit of the Hickman line over the PICC line is that it has two separate lumens (valves) which means that treatment can be applied while at the same time blood tests can be taken. During my Methotrexate infusion, they could also apply saline solution at the same time to help support my bladder.

the main daily benefit for me is that the exit site is at my chest rather than my elbow which is better for both comfort and daily activities such as having a shower.

The Procedure.

Central Hickman Catheter
Central Hickman Catheter

From about midnight on the night before I was told not to eat or drink in preparation for the procedure. I was taken through to the operating room and asked to lie on the bench. The anaesthetist started to shave my chest while her colleague inserted a catheter into my wrist. She cleaned the area and then applied 3 doses of anaesthetic in a triangle from my neck around the right side of my chest. As the anaesthetic started to react, they applied a mild sedative (to help relax me noting that I still had my severe headache) via the catheter, and prepared the area by applying shields taped to my chest and face so that I couldn’t see the operation (and presumably to collect blood spray). They started by making incisions to the top of my neck either side of my collar bone. She passed a needle through the opening and into a vein which passes from my neck down under my chest into my heart. A guide wire is passed through the needle and advanced into the vein. A vein dilator is then passed over the wire to hold the vein open and make a seal. At this point the performed an x-Ray to check the position. I was fairly drowsy at this point, but was aware of what was going on. The staff reassured me as I went, telling me when to expect tugging and pulling, and talked me through the steps. Next they made an incision into my chest and passed the line just under the surface of the skin up to the site of the guide wire. The line was pushed into position and the guide wire was removed. The pulling and tugging at this stage was fairly strong and although I could feel what was happening, there was no pain, it was just a tugging sensation. After a few minutes, the entry and exit sites were stitched closed and a dressing was applied. The anaesthetist instructed her colleague to reverse the effect of sedation and another fluid was applied to my catheter. I became much more lucid and awake at this point and I could feel my headache again. I was sent back to my bed for a short while. A few minutes later a porter arrived to take me for a chest X-ray. 30 minutes later the doctor confirmed the line was in the correct place and was ready to use. The whole process probably took an hour and I was surprised how quickly it was ready for use. I was expecting to feel pain as the anaesthetic wore off, but the pain was no greater than a small cut. My collar bone was a little swollen and was a little tender for the next couple of days and it’s taken me a while to get used to sleeping with the line in. The top stitches will come out tomorrow (after 5 days) which I’m looking forward to as they’re starting to rub a little. The stitch at the exit site will be removed after 2 weeks. I have also had a bit of an allergic reaction to the dressing which has made the area a little red and itchy, but this is manageable. Re-dressing tomorrow should help relieve this.

Sore Stitches
Sore Stitches
Advertisements

Peripherally Inserted Central Catheter (PICC line)

What is it and when is it used?

The PICC line is a type of catheter which can last up to six months and is much better than having standard catheters which need to be replaced every 2-3 days.

The line comprises a thin tube which passes through a clamp and valve and enters the body through a large vein normally on the inside of the elbow. The tube follows this main vein underneath the bicep muscle through the shoulder joint around under the clavicle (the collar bone). It then travels down and stops just short of the heart.

How is it inserted?

I started with an anaesthetic cream applied to the entry location which would numb the veins (I’m left handed so asked for it to pass into my right arm). This was left for about 30 minutes. I was expecting there would be a a strange tickling sensation or even pain to this procedure. The needle was a little longer than a normal catheter needle but I barely felt this go in. Once the vein was found, the tube was gently pushed to the correct length. The nurse was fairly experienced and using marks on the tube she could gauge how far round it had gone. Once it had passed into my shoulder, she asked me to look down and to the right to help the tube pass downward at a branch in the neck. Once located, she tested the line to make sure blood could flow out and a saline flush could flow inwards. Then a dressing was prepared and applied and the valve was locked off.

PICC line inserted at right elbow.
PICC line inserted at right elbow.

As an additional safety check, I was sent to the x-ray department to check the tube was correctly located.

I asked to look at the x-Ray and although I could see the line, it was difficult with untrained eyes to follow it’s complete path.

I sometimes get a little nervous (perhaps more at the thought) of these procedures, but I can honestly say, they could have done this without me noticing. The only thing I felt was a slight pressure in my arm as the needle was inserted.

Since having the line in it’s been much more comfortable and flexible to live with and I can barely feel the intravenous chemicals passing through using this system when compared to the standard catheters.

Procedures – a catheter

I thought I’d talk about some of the procedures that I’ve so far been through and explain a little about what they’re used for, why and more importantly what it feels like.

Today, I’d like to talk about the Catheter, anyone who’s been in hospital for a few days will have experienced these, but for me it’s a fairly new experience.

What is it?

Top of wrist

Top of wrist

A catheter is a small tube with a valve that is inserted into a vein usually below the elbow.

they can be placed at any point, usually where the larger veins are, in my experience (I’ve had about 8 inserted over the last couple of weeks) I prefer them to be in the forearm as it’s easier to write and shower than when it’s in the wrist or elbow.

They’re inserted using a needle which is relatively pain free (a small scratch) which is then removed leaving a tube in place. It is secured using a waterproof adhesive label, although this sometimes need replacing after a shower.

Underside of forearm
Underside of forearm

What does it do?

A catheter is used to apply fluids (I’m currently hooked up to a saline drip to make sure my bladder is fully flushed through ready for treatment) it can also be used to apply medicines such as ‘intravenous paracetamol’ which is more potent and fast acting than tablet form. It can also be used for taking blood samples rather than having to puncture the skin several times.

What are the side effects/downsides?

Sometimes if they’re inserted or removed a little quickly they can bruise is the skin as a little blood is let out under the skin. Otherwise, I’ve experienced no worrying or painful experiences, the medical nurses apply these regularly and can help with any concerns.

Bruise from removal from a small vein.
Bruise from removal from a small vein.

The downside to these kind of catheters is that they need to be removed every two to three days as they can begin to get clogged up and uncomfortable. Between each application of fluid, the nurse will flush the line with fluid to reduce this risk, but as a precaution, and for the ease of the nursing staff during a long term stay, they may decide to insert a PICC line or a Hickman line. I’ll be having one of these inserted tomorrow, so I’ll tell you how it goes 🙂

Saline solution
Saline solution