Thursday, July 10, 2014

Independence Day came a day early this year

I intentionally try to refrain from complaining on the blog.  Indulging in complaining merely feeds the negative energy that generates the need to complain.  It is easier to overcome the cause of the complaint if I do not validate it with a complaint.  Also, I've found that blog-complaining sounds even more whiny than verbal complaining, and I do not want SGPC to become a festival of whining.

An introduction like that can only mean that I am about to unleash a festival of whining.

The problem has been with my PICC line.  PICC stands for peripherally inserted central catheter.  To fully understand the scope of the problem, you have to understand the nature of the PICC line.

On March 6th, 2014, almost FOUR MONTHS AGO, my PICC line was installed.  Its physical manifestation is as follows:
image source
PICC line close-up
This is very similar to mine.  Differences are that my butterfly-shaped piece, here outlined in dashed lines, is much larger; the line dangling from the arm is shorter; and my line was placed above the elbow, not below.  image source 
Because the end of the PICC line is external, extreme care must be taken to keep it secure and to protect it from infection.  These are achieved by 1) the butterfly clip strongly adhering to the skin and holding the line in place, 2) a quarter-sized antibacterial patch that rests on top of the point-of-entry for the PICC line into the skin, and 3) a 3x3 inch piece of clear plastic adhesive covering items 1, 2, and the area surrounding the point of entry (light blue square in the image above).

At least once per week for the past 17 weeks, items 1, 2, and 3 have been removed and swapped out for fresh ones.  Also, the skin has been excessively swabbed with alcohol at each exchange.  If one had a PICC line for a week or two these things would be no problem, but I had my PICC line for WEEKS.  Over time, all of these things are a bit harsh on one's skin.  Just a bit.

Needless to say, my skin started to irreversibly complain in mid-May.  Since then it has grown increasingly itchy and painful.  The skin under the adhesive was perennially red.  It felt alternately like poison ivy, or a bad sunburn, or a skinned knee, or all three at once in different quadrants.  Then I would have a day where it didn't bother me at all and I'd think it was getting better, only to wake up to another day of PICC line perturbations.    

During my most recent hospital stay, a wound specialist visited me to try and troubleshoot my growing skin issues.  The butterfly clip and the antibacterial patch were non-negotiable, but two different types of adhesive coverings were tried.  Nothing improved the condition of my skin around the PICC line.  

Last Wednesday, after yet another dressing change that left me raw and burning, I realized that my suffering was getting to be a bit ridiculous.  I had started waking myself up at night, scratching at my PICC line in my sleep.  I had to ice it to get any relief at all.  It had even started to ooze.  On Wednesday I noticed that my skin ooze was seeping through the adhesive dressing.  That, my friends, was the last straw.  I messaged Dr. O's office and begged to come in on Thursday (July 3rd) and find a solution.

On Thursdays Dr. O is out of the clinic, so it was just the nurse and I.  She removed all of the accoutrements, noting that the skin under the butterfly clip was much worse than the 3x3 patch of skin under the adhesive.  She channelled some old-school nursing skills and used steri strips to weave a PICC-securing mechanism to replace the insulting butterfly clip.  After she got this far, she decided that my skin looked "yeasty" (gross!) and swabbed it for a culture.  (Dr. O takes a culture every time I'm neutropenic, so only 6 days prior to this swab we knew that I did not have a yeast infection around the PICC line.)  Then she called Dr. O to discuss the situation.  I could overhear the nurse's side of the conversation, and she adequately described my PICC line site in response to Dr. O's questions.  Finally, the nurse mentioned her instinct that it could be "yeasty".  The conversation ended shortly after that, presumably because upon hearing suspicions of infection Dr. O gave the orders to remove my PICC line.

The nurse came back into the room and pulled out my PICC line.  Just like that.  It didn't hurt; it hardly felt funny.  One minute I had a PICC line, the next minute I didn't.  That was it.  No blood squirting out of my arm, no stitches, no bandage, nothing.  Just a hole in my arm the size of a dried-up pea, surrounded by a large swath of angry skin.


Since then I have been taking an oral antifungal medicine and applying topical antifungal medicine, but on Monday Dr. O told me that the cultures came back negative.  She nonetheless wants me to keep up these medicines until three days after my skin has cleared up.  A negative culture result does not necessarily rule out something infectious.

The skin is slowly healing.  It was very painful all weekend, and the pain has receded into a basic itchiness.  The area that used to be covered by the butterfly clip is still clearly demarcated by a red triangle.

Although I am enjoying this sweet freedom from having a PICC line, the most notable feature of which is the ability to hop in the shower anytime I want to without having someone wrap my PICC line arm in Glad Press-and-Seal, it is unfortunate that it had to be pulled.  The PICC line would be the safest way to administer the remaining three doses of taxotere.  In the absence of the PICC line, the nurses will start an IV in my hand and put the taxotere there.  The risk associated with this approach is that if the taxotere leaks out of the vein, it can cause severe burns and permanent damage to the nearby tissues.  Dr. O specifically mentioned the possibility of tendon damage that could inhibit my ability to type.  Gulp.  I think the risk is low, but the consequences are high.  My plan is to drink plenty of water prior to treatment tomorrow.  And cross my fingers for no taxotere leakage.  Also, it is entirely possible that we'll put a new PICC line in after the skin has healed.  That would be okay.          

1 comment:

  1. Thinking of you with lots of love and hugs and strong hopes for no taxotere leakage! I hope your cells have all respected my stern talking to. :) I know what you mean about how it felt like cramming for an exam at the last minute!! Xxxxxxxxxxxxxxxxxxxxxx