Before I begin with the events of the day I am going to explain some of the things I am talking about, mainly PICC lines, central lines and plain old peripheral IV (cannula).
A peripheral IV line (PIV or PVC) is the probably the most common type of IV access. It consists of a small catheter a few centimeters long that is inserted through the skin and into a peripheral vein. While we most often think of these IV lines being placed in the arms or hands, they may be placed in the leg or foot as well. In infants scalp veins can also be used.
This type of IV access cannot be used long term due mainly to the increased risk of infection. Depending on which country your from the national guidelines for replacing these IVs are somewhere in the range of 72-96 hours.
Central IV lines flow through a catheter with its tip within a large vein, usually the superior vena cava or inferior vena cava, or within the right atrium of the heart. This has several advantages over a peripheral IV:
- It can deliver fluids and medications that would be overly irritating to peripheral veins because of their concentration or chemical composition. Like chemotherapy drugs and total parenteral nutrition.
- Medications reach the heart immediately, and are quickly distributed to the rest of the body.
- There is room for multiple parallel compartments (lumen) within the catheter, so that multiple medications can be delivered at once even if they would not be chemically compatible within a single tube.
- Caregivers can measure central venous pressure and other physiological variables through the line.
Central IV lines carry risks of bleeding, infection, gangrene, thromboembolism and gas embolism. They are often more difficult to insert correctly as the veins are not usually palpable and rely on an experienced clinician knowing the appropriate landmarks and/or using an ultrasound probe to safely locate and enter the vein. Surrounding structures, such as the pleura and carotid artery are also at risk of damage with the potential for pneumothorax or even cannulation of the artery.
Peripherally inserted central catheter lines or PICC lines are used when intravenous access is required over a prolonged period of time or when the material to be infused would cause quick damage and early failure of a peripheral IV, and when a conventional central line may be too dangerous to attempt.
The insertion site requires better protection than that of a peripheral IV, due to the higher risk of serious infection if bacteria travel up the catheter. However, a PICC poses less of a systemic infection risk than other central IVs, because the insertion site is usually cooler and dryer than the sites typically used for other central lines. This helps to slow the growth of bacteria which could reach the bloodstream by traveling under the skin along the outside of the catheter.
The chief advantage of a PICC over other types of central lines is that it is safer to insert with a relatively low risk of uncontrollable bleeding and essentially no risks of damage to the lungs or major blood vessels. It is also externally unobtrusive, and with proper hygiene, care, and some good luck, can be left in place for months to years if needed for patients who require extended treatment.
The chief disadvantage is that it must be inserted and then travel through a relatively small peripheral vein which can take a less predictable course on the way to the superior vena cava and is therefore somewhat more time consuming and more technically difficult to place in some patients.
So now that everyone is up to speed we can proceed with the days "event".
Ben was to have his PICC line inserted today. This was a marathon event. Sites in his arms were numbed and we waited as Dr. Suzdec was sure she could get one in his arms. To cut a long story short she could NOT get one in his arms...nor his legs so she eventually got one in his head. The whole thing was an ordeal and I don't really want to relive it in text.
I was assured this was a "good" PICC line and that the formality of confirmation Xray was all that stood between us and the start of PICC care teaching.
Sound too good to be true??? Yeah....it was!!!
The first two X-rays the line could not be visualized. The second two X-Rays could not view it. FINALLY the third set of two X-rays were read and they too could not visualize the flipping line!!!!!
ARGH!!!
So the nurse very calmly explained that the PICC line in Ben's head is, at least for now, useless! Not sure what is in store for us tomorrow. The doctor isn't supposed to be in tomorrow but she assured the nurse she would be and that she would sit down with a radiologist and go over the X-rays. So for now there STILL is no plan....maybe tomorrow??
Happy Mother's Day to me huh??? Looks like mine will be spent in the IWK :(
