Picc Questions

Those seem like very concerning things, Nerdyginger. I've emailed someone I think can help, as I never had a PICC line.

I would be concerned with blood clots though. The fact that they can't pull back on the syringe indicates something is wrong. Do you flush with heparin after each use? You're blood could also have too much fibrin (thanks to Lyme) that is making your blood clot faster than normal.

The gurgling sounds shouldn't be happening either, but I have no idea what would cause that, and I don't want to guess and possibly have you worry about something you don't need to.

Hi nerdygingergal -

So sorry you are having issues with the line. I AM TOO! Been a tough couple of weeks...

I had tremendous problems with my port after it was installed. I think PICC installation issues are a little less common as long as you heal, but your biggest risk is from infection, which you obviously know. But also, it sometimes take awhile to get all the kinks worked out and to learn how YOUR PICC works for you - I've learned that everyone's experience is just slightly unique.

I am SO glad you have a new nurse. The biggest risk you have is infection so I'm glad you recognized everything she was doing incorrectly (don't they train these "professionals" before sending them out???) Please be sure her supervisor is well aware. It's almost always a training issue, not that the person isn't a good care taker.

Gurgling issue:
This usually means the tip of the catheter (that is supposed to be in the atrium) is not in it deep enough or has tipped "up". You need to have a scan done so that the surgeon can ensure it's in the right spot. Sometimes, a nurse can use a little higher force to infuse and it can reposition it but this is definitely a "get to the hospital" situation. Not dangerous, but you can't really use the PICC without getting it checked out.

Positional issues - catheter:
First, not being able to get a blood draw is very common and doesn't necessarily indicate a critical problem. They happen for odd reasons--likely, the tip of the catheter can sometimes be "positional" and get sucked up next to tissue in the atrium. You can infuse (push fluids through) but can't draw (pull fluids out) just because of the proximity of the catheter's opening and how close it is next to surrounding tissues. I warn the nurses (and have trained my usual nurse) that whenever they do a draw they must go very slowly - a quick jerky reaction is likely how the catcher is sucking up the tissue and creating a block. S-L-O-W and gentle.

Second is that PICC lines are susceptible to shifting out of position and can sometimes get too deep into the atrium (even a fraction of an inch can make it out of place). I had major issues getting the pocket of tissues that is supposed to form around the port to heal to keep ti in place, so it kept shifting and shredding the tissues (VERY painful and caused a lot of swelling for months--the nurses and surgeon kept telling me I "should have healed by now" and started telling me it was in my head...) Eventually it healed -- but out of place so the catheter ended up about 1 1/2 inches too deep so that caused a whole other set of issues.

Positional issues - needle:
This doesn't apply to you but including it in case others with ports are interested - these newer ports have a very small membrane "target" area into which the nurses are inserting the IV needle. I've gone through 2 dozen nurses who all had problems accessing me - it's very painful (for me) and stressful (for everyone involved) and I waste a ton of IV needles. Except one angel of a nurse who I finally demanded. She has 35 yrs experience and it makes a huge difference. My trouble also started when she hurt her back and the nurses started rotating again.........

Tissue buildup:
So not being able to get a blood draw doesn't necessarily mean you have a blood clot. Although,lyme & co does sometimes cause hyper-coagulation (and by-and-large, the home health care people are clueless about lyme & co so you may have to bring this up), but the heparin (and many herbs if you're on herbs) usually do a good job of preventing this. If not, perhaps you need more.

Often, instead of a blood clot it's tissue or "sheath" buildup that might be too close to the opening of the catheter, perhaps even scar tissue that is forming around it (although maybe you haven't had yours in long enough for scar tissue to form) but I also think yeast/fungus can attach to the catheter. It's a foreign body that isn't supposed to be there so the body kind of likes to--I don't know--cover it with stuff. LOL something like that.

Anyway, the ATP/cathflo is an enzyme that likes to break down tissue so it's helping whether it's a blood clot or tissue build up. The frequency of the blockages might be an issue - might be too soon to tell. Will be good to hear what the MD says. I had to go back to the surgeon twice to have my port checked out - of course, it never acts up while I'm there.

I'm also having trouble nearly every couple of days with blockages so I'm trouble-shooting as well. I've had my port in for 18 months and just started a 2nd antibiotic (vancomycin) 8 wks ago. These issues started getting bad when I increased my doses to every 12 hrs... OR... these issues got bad when my nurse hurt her back and I've had a different nurse come every week. I have a call into my MD so I'll let you know what we decide to do.

Please let us know how your visit at the hospital goes. And please post any other questions or concerns you have... sometimes the IV route goes very smoothly for people, others have a rough start.

Hope this is helpful -

-p

Post Edited (Pirouette) : 5/24/2016 11:29:13 AM (GMT-6)

tickbite666--

Did you ever experience sensitivity to the clear protective bandage covering used on your arm?

I am having problems with blistering up underneath mine. It was really bad at first but then I switched to a bandage that created fewer reactions in patients. It really calmed down then but now it's blistering again (sometimes very itchy). I think there is an allergy to it but then it causes inflammation in the tissues beneath it and around the port, which then makes it harder for the nurses to access me (and it's already hard and complicated as it is). I'm doing infusions 3x/day so I don't ever get a break for it to air out or heal anymore. Every solution they use to help protect from the glues makes it worse...

Pls let me know if you have any ideas. Thx

-p

Yes - I know it's an allergy to the adhesive. The sorbaview shield is pretty much what I started with and it was worse than what I'm using now.

-p

Actually - the sorbaview look like the one I previously used but it's not the same. I don't think they make a sorbaview for the IV port like I have - aren't they mainly used for PICC lines?

The bandage I use is at least 4"x5" because the huber needle stands up almost 3/4" and they need a protected area of a couple inches.

I've gone through 3 different products so I doubt I'm going to find an adhesive that I won't react to but wondering if there is some protection product for the skin I can apply first. Again, what I've used hasn't helped.

-p

Post Edited (Pirouette) : 5/27/2016 2:37:24 PM (GMT-6)

Is it reaction to the cloroprep...the last nurse said let it air dry before putting the tegaderm..also he used this hepatape ,cloth hypo @lergenic ..very cool...a cheep bandaid broke me out ...port has gone ok this far thanks for pull back technique and i had to school a nurse too..was like can you clean gloves after he answered his phone. ..?...can one put a picc in either arm? And can you get insurance to cover port ?.

Hi bluelyme -

I have an IV port installed in my chest - this is not a PICC line that is installed in the arm. So the port cavity is underneath the flesh and to access me, the nurse punches a special IV needle through my flesh (like a tack) and into a membrane covering the port. This is not for the inexperienced - it's a very small invisible target.

I swear - I had a young male nurse (as sweet as he could be) come a couple of weeks ago. He casually dismissed the importance of wearing a mask and tossed my IV needle around unsterile surfaces and did a lot of the prep w/ out gives. OK, not serious infractions but then I noticed his dirty fingernails. I stopped him from doing a few things but tolerated the rest - I am on a ton of abx so it's unlikely that anything will come of it...

Thankfully, I had to deaccess the needle the next day because I wasn't able to infuse so a different nurse reaccessed me without all the ridiculous unsterile issues. And needlesstosay, once I get my port issues figured out, I have a call into his supervisor to suggest she implement some updated training - he already has great bedside manner (with the exception of commenting that I was wearing my robe "just for him"...sigh...). But he was a sweet guy and you can't teach that.

So - back to the original problem:
- I've had no difference in reactions to the cleaning solutions - betadine, chloroprep or any of the other available products they use. Sometimes I react, sometimes I don't.

- But I always make sure the area is dry - and the nurses are good about not rushing, too. I am on them like white on rice.

- They have told me there are no other bandage products to try - I'm using the top product for sensitive skin and won't let me substitute for other types of non-IV products (likely due to the proximity to the heart and all the other very specific functions this type of bandage provides in the way it attaches to the skin, blocks MRSA type infections, allows the skin to breathe, etc...

- I automatically respond if the sun touches any part of the bandage or if I sweat.

There is a possible catalyst - perhaps not having anything to do with the products and something my body is producing and once I get one burn, there's no turning back. The burn has to clear entirely before reapplying any other product, which takes days. I've had a burn exposed for 2 weeks and it's just now healing (which again, makes me lean toward the possibility that something in my body has changed and is making it difficult for me to heal these burns). I wonder if maybe I have a yeasty area on my skin that isn't producing other symptoms. I started on Ketoconazole again, to see if that makes any difference.

I've been trouble-shooting this in multiple ways for 18 months so my take away is that I need to somehow prevent the burns in the first place. Not easy to do when I have twice-daily infusions 7 days a week.

The good news is that I have missed my previous two vanco infusions and my bart herxing has been minimal - body spasms and some bone pain in legs got a lot worse but that's it. I could also be having a nervous break down but not sure if that's related yet... LOL

Anyway, thank you all for your suggestions. If you happen to come across a magical solution, besides ripping the &*$%$# thing out, please let me know. ;)

-p

Post Edited (Pirouette) : 5/27/2016 2:37:49 PM (GMT-6)

thanks bluelyme - I had not heard of that product - definitely going to try it. will let you know results.

-p

Hi Krimpet - yes, that was me. I just laughed. He didn't have the hands of a car mechanic but, you know, in this arena, dirty is dirty. He also brushed off several other sterile protocols. He's young and one very good thing he has going for him is that he was very sweet and attentive. His supervisor can correct the other stuff with proper training (i have no doubt they don't train their new nurses and this is an even bigger problem).

Yes - the dressing changes do help. Although you can also end up with too frequent changes is you're a little sensitive to the isoprene (alcohol sterilizing solution).

-p