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Insertion of the PICC Line

Posted by on February 8, 2010 in IL-2, Medical Procedures and Other Drugs, My Health Updates - No comments

I’ve checked in on the 9th floor, which is the top floor of the medical facility. It’s like the Penthouse floor. They’ve got a library of DVDs, a collection of snacks, an “arts and crafts cart” that is rolled around every once in a while, catheters, various machines that ping, a private bathroom, a rainbow of various needles for plugging tubes into your veins and a cool little minifridge of the sort you had in your college dorm.

I had the PICC line inserted about an hour ago. PICC is acronymese for “peripherally inserted central catheter.” Think of it as an IV line on steroids, allowing for the injection of massive doses of whatever – in my case interleukin – directly into the biggest veins in your chest. A specially trained PICC nurse came into my room, politely kicked everybody out and commenced cocooning me in sterile blue sheets. I warned him that I have a tendency to pass out around needles, and have done so around simple blood draws and IV insertions, so he should be doubly wary with this bucket of wiring, needles and blankets he was rolling in that I didn’t fall out of the 9th story window.

Like so many of the medical staff here at Duke, though, he was very good at his job. First he distracted me by explaining what he was getting ready to do. For example, I was getting a “double lumen power catheter.” Power catheter? Hell yes. Talk about an egobooster. I tried to step it up and asked for the Monster Plug but he just looked at me blankly.  Lumen is simply another term for “port.” A double lumen means that they have inserted not one IV but two IVs that run together through the catheter but are completely separate. This allows the doctors to pump various cocktails into my bloodstream without mixing them together and creating the medical equivalent of a lab explosion. He explained that the “power port” was so that large quantities of interleukin could be pumped directly into the Superior Vena Cava, which is the largest vein in the body, running vertically up the center of your chest and emptying large quantities of blood into the heart like the Mississippi dumping its muddy waters into the Gulf.

To get the IV lines to the Vena Cava, the PICC nurse had to insert the catheter into the inside of the upper arm, threading it into the vein on the inside of your bicep. Needling this larger tubing into the veins nearer the wrist or inside of the elbow, where IVs are usually inserted, would collapse the vein. Therefore, he wrapped a tourniquet around my upper arm and found the vein running along the bicep, which continues onward along your arm and aound the front of your shoulder, cutting over across the chest before dropping down, heartward, where it washes into the Vena Cava.

Threading that vein is a challenging job, but he assured me that he had done this thousands of times and I had nothing to worry about. And let’s be honest:  I was worried. The week before, Dr. Morse, the oncologist who administers the IL-2 treatment, noted that he liked for his patients to check in early so that the PICC line could be put properly into place, as it could take a while. “Sometimes the lines veer off and you have to withdraw start again, so we need to have time to make sure it’s in right before we come in and start administering the treatment.”

I’m sorry. Veer off?

Images of plastic tubing pushing through my nostril.

The nurse, however, was a pro. He brought in an ultrasound machine to guide him as he thread the catheter through my veins. “Want to take a look?” he asked. Of course I did.  We looked at the interior of my arm pulsing on the ultrasound’s screen, him pointing to two large black holes in the midst of a sea of white and grey murk. “Those larger black holes are cross sections of the two veins we use,” he said. “We’re going to use this one here, as it’s larger. Now watch this.” He pressed the flesh of my arm with the ultrasound knob and the two black holes squished down like they were winking at me.

“Cool,” I said.

“Yeah,” he said.

By the time he got done distracting me with all the cool toys, he had injected some local anesthesia into my bicep and was ready to go. He added more blue wrapping around the arm so that only a square patch of flesh showed through and asked me to look away or else wear a mask. “Everything has to be perfectly sterile, and that’s really what takes up most of the time – laying out the blankets, covering you up , me putting on all this,” he said gesturing at the blue hairnet and white gloves and a mask tied around his mouth.

“You feel  a little pressure but it won’t hurt.” And he was right. He expertly pushed the tubing through the vein in my arm, around through my chest and dumped it into the Vena Cava and we were done. Now I walk around with a dual IV lines dangling from my arm, capped at the head, like a hydra-headed coil of electrical wiring gone rogue. The caps are even different colors, red and blue, and I can’t help but wonder if I touch the two together whether it will start some guys stalled engine in the parking lot.

The first dose injections commence at 6 p.m.

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