PICCs, pumps and purses pt.1

Yesterday was day 1 of treatment. … and it was a long day.

Bruce works around the corner from both of the hospitals where I had appointments today so we walked together. It was going to be a lot of waiting around so I encouraged Bruce to go to work and meet me at the end of the day to take me home. We hugged and kissed goodbye on the street corner and we went our separate ways, looking over our shoulders as we parted, nervously smiling and waving encouragingly. Both of us trying to be strong. It was a tender loving moment between us and I held back a tear or two.

My first appointment was at 10:00 a.m. at the Vascular Interventional RadiologyDepartment, Toronto General Hospital, to have a Peripherally Inserted Central Catheter (PICC Line) inserted in my upper arm. This is the thing that scared me the most. I gave me the heebie-jeebies. The procedure uses local freezing so once the freezing was set I didn’t really feel a thing although, I could tell something was happening through dull sensations but there was not pain.

A resident assisted by a technician did the insertion. Although the resident knew the procedure I don’t think the he was very experienced. The technician provided a lot of guidance.

After land marking the vein with ultrasound they punched a hole on the inside of my upper arm and fed a thin tube through the opening, along the vein, up the arm, over the shoulder and into a larger vein stopping short of the heart. During all this time they followed the catheter on an x-ray, negotiating the catheter along the vein.

I was conscious through the whole procedure. I don’t profess to understand their conversation but I couldn’t help but try to interpret what they were discussing. Apparently, my commitment to exercise has resulted in muscular arms, which resulted in some issue with my veins so they had to pause the procedure momentarily to dilate the vein so the catheter could pass through. They also ran into a couple of situations where the catheter would bend or fold back on itself so they had to insert a wire to make the catheter stronger so they could straighten out the catheter and push it a little bit further.

An hour later my 42.5 cm PICC line was complete.

I had a couple of hours to kill before my chemo appointment so I decided to do a little shopping and take myself out for lunch. I needed to get some sweat pants and casual shirts to make my treatments a little easier. I went to Winners a few blocks from the hospital.

It was the first day of winter in Toronto. We had our first temperatures below 0C, a wind chill effect and a little bit of snow, so I had bundled up that morning for my walk with Bruce. I had worn a hoodie under my winter bomber jacket.

After carrying around my courier bag, hangers of clothes and dressing and undressing in the store’s change room I noticed blood running down my arm. It was more than a little bit but it didn’t seem like a lot but It was more than I was comfortable with … and it had soaked the inside arm of my hoodie. I was alarmed but I remained calm.

I skipped lunch and headed to the chemo department at Princess Margaret Cancer Care Centre an hour early hoping that they would be able to see me ahead of my scheduled appointment.

The reception staff triaged my visit and a nurse cleaned me up while other staff walked by oohing and awing and commenting on how much blood there was. They weren’t very reassuring but at the same time I was relieved that it wasn’t serious.

Just before 2:00 my chemo nurse started an IV with saline solution in preparation for the purple-coloured mitomyicin. Mitomycin, a chemotherapy medicine, is a vesicant and can cause extensive tissue damage and blistering if it escapes from the vein.  The nurse or doctor who gives this drug must be carefully trained. The mitomycin is manually and slowly injected into the IV line. I will receive the mitomycin as a single dose on the first day of each chemotherapy cycle.

Once the mitomycin was done it was time to set up the Fluorouracil(5-fu) pump. This was not what I was expecting.

The 5-fu comes in a 500 ml IV bag a tube passes through a battery-operated pump, which delivers a dose along an IV tube to the PICC line. Every 30 seconds the pump makes a little whirring sound and delivers 0.01 mL of 5-fu into my vein.

There are some potential problems that are signalled with a loud alarm. The most common problem is a kink or twist in the IV line preventing the flow of the 5-fu or the batteries could die or I could be late for an appointment and the 5-fu runs out. All easily remedied.

I am attached to the IV bag, pump and tube 24 hours a day for five days and I visit the hospital every 24 hours to have the IV bag changed. The kit and I are never more than two-and-a-half feet apart.

The nurse gave me an oversized reusable shopping bag to carry my pump and IV bag of 5-fu. The bag isn’t very efficient.

When I got home I found a man purse that everything fit into and I can easily wear it over my shoulder.

I am learning how to dress, undress, go to the bathroom and sleep and not kink the line or leave the kit behind. It’s awkward but I am figuring it out.

References

Chemocare

www.chemocare.com