Saturday, January 10, 2009

Hickman line

Last Friday, I had a Hickman line installed. This is a kind of central venous access port: a device running from inside one of the major veins that drains into my heart to the surface of my chest. As long as I have the port, I don't have to get stuck for IVs or blood draws. Putting the chemotherapy drugs into a major vein also helps dilute their corrosive effects more quickly; these drugs can be damaging to the smaller veins IV lines are placed into.

Some types of port (I think called portacath) are completely under the skin. These types do require puncturing the skin, but there's not the risk of missing or damaging the vein there is with a normal needle stick. The under the skin type has the lowest risk of infection and other complications and seems to be preferred. Because of my particular treatment regimen, however, my doctors believed a Hickman line would work better for me. This device has a catheter that comes out of my chest; it splits into two lines ("lumens") that hang down about four inches.

One of the symptoms of the tumor in my chest was that I could only sleep on my left side. I asked the surgeon to place the port so I would still be comfortable sleeping on my left side, and he put it on the right (the line exits my chest at armpit level about 2-3 inches away from my shoulder). The pain afterwards was never bad (I didn't take anything for it). But the location of the discomfort surprised me: I thought it would be restricted to my chest, when actually my shoulder movement has been severely restricted. Even now, a week later, I can just barely raise my right arm to a 90ยบ angle without pain. Had the surgeon placed the port on my left side (he said this was where the normally place it, because the anatomy makes the surgery easier over there), I cannot imagine how I would have be able to sleep. It is an absolutely terrifying thought.

I was not happy with the care instructions from the surgeon or the discharge nurse at the hospital. Fortunately, I met with one of my oncology nurses right after my line placement: she put a Biopatch (a 1" round antimicrobial sponge) around where the line exits my chest, and covered the whole area with an adhesive patch that looks like Saran wrap. Now I don't have to worry about getting the area wet (and so susceptible to infection) when I shower. Another oncology nurse changed my dressing yesterday (a week later).

I finished my first five-day course of chemotherapy yesterday. Despite my fears and complaints regarding the Hickman line, I have been very happy with how it is working. I meet with the surgeon in another ten days to have some stitches removed, and hope to express my gratitude for making this part of my treatment a little easier.

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