Our llmd is talking clindimycin plus zith for daughter with picc...
I just read that you can only do zith through central line...No way can she tolerate orals right now.
I am still in process of convincing LLMD of the this...
So...what is a central line?
Has anyone had one?
Char
Posted by Melanie Reber (Member # 3707) on :
Good morning Char,
Hope the following info is helpful.
My best, Melanie
**************************************
Central Line Catheters
Implantable Ports
Explanation:
This is a small "port" made of stainless steel, titanium, plastic, polysulfone or a combination. This port holds a small amount of an anticlotting material (heparin) to keep it from clotting off from the body's natural defenses. It is put entirely under your skin, generally in the upper chest surgically. A small incision is made by a surgeon skilled in the procedure after you are given local anesthesia. A second small incision is made nearby to attach the port to a catheter. The catheter is invisible inside your body and is threaded in the large vein that leads to the area near the heart. The tip of the catheter rests just above the heart's right atrium in the large vein called the vena cava. A few stitches are left in place until your skin completely heals over. Healing is very quick and the port can be used by your doctor or nurse right away.
With a port, a raised disk is felt underneath the skin. Blood is drawn or medication delivered by placing a needle through the overlying skin into the port or reservoir. A special needle, called a "non-coring" needle is used in the port. If your IV is to be left in place, this needle is pre-bent to a 90 degree angle, and taped and secured in place and attached to the IV that is running.
Ports are flushed with heparin between uses. They are also flushed monthly if they have not been used at all to prevent it from clotting. Ports may be left in for years. When not in use they require no care other than the monthly flushes as discussed. A simple surgery is needed to remove them when they are no longer needed.
Types:
MediPort-
Port-A-Cath-
Infuse-A-Port-
PASport- A type of peripheral port, the PASport is smaller than a regular port so that it can be inserted into the anterior forearm.
These central line devices are also inserted surgically with a local anesthetic. They are usually placed in the upper chest although the femoral vein in the groin may also be used. With these catheters, there is no "port", and the catheter comes out from your body for about 12 inches. It has a special cap on the end where IV's are connected. Between uses, the cap is left in place to keep the catheter sealed from the air. Caps are usually changed at least every 3 days.
Most of these catheters are single or one line, but there are catheters which have double lumens and even triple lumens. Caregivers call lumens the number of parts to the catheter with separate caps that you have outside your body. Two or three different lumens allow caregivers to give you more than one IV medication or solution at a time.
No needles need to be put into the patient at all to use these catheters. The IV's are connected directly to the end of the catheter where the cap is. All of the same kinds of IV's that can be given in a port can also be given in one of these catheters. Lab specimens may also be drawn from these lines. The exact type of the catheter will determine the flushing procedures and care of them.
You will have a dressing placed over the site where these catheters enter the body. The size and kind of dressing varies depending upon the protocol of the institution. Changes of the dressing will also vary by institution and are anywhere from daily to weekly.
There are restrictions on swimming while these catheters are in place. Showers are generally allowed once the surgical site heals. They may also be left in place for long periods of time, and are removed relatively easily without surgery.
Types:
Broviac- The smaller Broviac� line is often used for the administration of IV therapy. Broviac catheters need daily heparin flushes when not in use.
Hickman- The larger Hickman� line is reserved for additional venous access and blood withdrawal. Hickman catheters need daily heparin flushes when not in use.
Groshong- Groshong catheters need only normal saline (sterile salt-water) flushes weekly when not in use. They have a built-in valve to prevent clotting. A special valve on the tip of a catheter (used on PICCs, external tunneled catheters, and ports) developed by Dr. Leroy Groshong in 1978. The closed rounded tip allows fluids to flow in or out, but the valve remains closed when not in use. Groshong� catheters are three to seven times more likely than Hickman� catheters to suffer valve-related complete catheter malfunction
Possible problems:
Because these catheters are open into the body, there is a risk for infection. Their care requires meticulous technique. If the line becomes infected, it may need to be removed. This is called Sepsis, and can quickly become life threatening.
These lines do, at times, clot off despite proper flushing. There are medications which may be used to dissolve the clot inside the catheter.
PICC (Peripherally Inserted Central Catheter)
Explanation:
PICCs are catheters which are inserted without surgery into one of the large veins in the antecubital area of the arm (where the arm bends). Peripherally inserted central catheter (PICC) lines, unlike central catheters and ports, are not directly inserted into the central vein. A PICC line is inserted into a large vein in the arm and advanced forward into the larger subclavian vein. These lines can be inserted in the home, physician's offices or at the bedside in the hospital. It takes about 45 minutes to an hour to fully insert a PICC. The PICC is threaded into your large vein via an introducer needle. The needle is removed after the catheter is threaded through it. What you have left is about 6 to 10 inches of a flexible plastic catheter coming from the bend in your arm that has a dressing on it. On the end of the PICC is a cap much like with the Groshong or Hickman. This is where the IV's are attached or blood specimens are removed.
The PICC looks like the Groshong or Hickman catheter, but in a different location. PICCs are used for the same things as other central lines. PICCs are generally left in place for a few weeks or months at most. They are removed easily just by pulling them from the vein. There may be a stitch to help hold them in place on your skin, but usually a special dressing tape is used. Your caregivers will tell you about limiting any activity and use of your arm that the PICC is in so that it is not accidentally dislodged. Your PICC may require daily care with flushes and dressing changes. You must have a large vein in the antecubital area (bend of your arm) in order to have a PICC.
Types:
Medline-
Midline catheter- A longer lasting IV catheter than a peripheral catheter designed for patients requiring one to four weeks of IV therapy who may have poor veins. The tip of the catheter ends approximately midway between the antecubital space and the head of the clavicle. Midline catheters can remain in place without being changed for up to five weeks.
Possible problems:
PICC catheters can cause irritation to the vein wall. This usually happens within the first 48 hours of insertion. Your arm above the catheter can become very red, tender and warm. This is called a local phlebitis. It usually resolves with heat and elevation of the arm. These lines do, at times, clot off despite proper flushing. There are medications which may be used to dissolve the clot inside the catheter.
When to call the doctor
Swelling of the area where the port is Shortness of breath or chest pain Redness, pain, tenderness around catheter or port Redness or tenderness along the arm vein in the upper arm (especially if you have a PICC line) Unexplained fever Catheter or port malfunction Pain with catheter or port injection/infusion Mental status changes Excessive tiredness Weight loss
When to go to the hospital
If your problems are not resolved with the call to your doctor, seek care in a hospital's Emergency Department. In particular, shortness of breath, chest pain, or sudden changes in mental status may indicate a dire emergency, and you should go to the Emergency Department immediately.
I have had 2 central lines this year. The name is rather explanatory. It is a central line to the body. A radiologist will insert , what amounts to a mid length IV line in a large vein in your daughters arm. It will travel down the length of the vein into the heart. This will allow an extended course of Iv antibiotics. It is a more efficient process than inserting an iv line into smaller veins every couple of days( saves the smaller veins) and allows stronger medications that only larger veins have the ability to carry to do accordingly. It only takes a few minutes to insert. They will put lidocaine or a topical ointment on after cleansing the area to prevent any discomfort. The doctor and hospital will give you the information and resources to use the device. The most important thing on your part is to keep the dressing around the picc line dry. This and the cleaning techniques that they give you is important to prevent infection. Disclaimer: I was a nurse and can describe what a central line is , where it goes, why it is used. All specifics regarding the medication, length of therapy, care and concerns, your physicians can and should address. I hope this helps you and my very best to you. Have a strong Sunday.
Posted by iceskater (Member # 8655) on :
Melanie's response above was much more in detail than mine. All excellent information. Refer to hers for all of the details, I just posted a very brief synopsis.
Posted by Melanie Reber (Member # 3707) on :
(hey Iceskater...I just happened to have this tucked away from a long time ago )
Posted by arg82 (Member # 161) on :
Hi Char,
A PICC line is actually a central line. I did Zithro through a PICC line for 2 months after 4 months of Rocephin back in 2002. So your daughter doesn't have to go with a chest line if she doesn't want to. BUT, if she's going to be on IVs for a while, I would seriously consider a port.
Feel free to talk to me about ports if you have questions (the link Melanie provided has info I posted a while ago about them). I have had mine since July 2004 and I love it, it really is wonderful and I'm so glad I got it. Plus you can swim in the summer if you de-access for a day between IV doses! A great advantage!
Peace and healing, Annie
Posted by NP40 (Member # 6711) on :
Char,
Jesse did 5 months of IV rocephin and zithromax through his PICC line. No problems whatsoever............well..........except for the fact he kept hooking the line on chairs, clothing, etc. and kept pulling his stitches out. Posted by AP (Member # 8430) on :
quote:Originally posted by NP40: Char,
Jesse did 5 months of IV rocephin and zithromax through his PICC line. No problems whatsoever............well..........except for the fact he kept hooking the line on chairs, clothing, etc. and kept pulling his stitches out.
I bought long boys socks and cut the actual foot band off, making a sleeve to put over my PICC... The long tube that was attached for my convienience was easily wrapped around my arm and stored under the sock elastic. It wasn't a big deal, those "socks" they hand out when you get the PICC are a joke.
Posted by arg82 (Member # 161) on :
quote:Originally posted by AP: I bought long boys socks and cut the actual foot band off, making a sleeve to put over my PICC... The long tube that was attached for my convienience was easily wrapped around my arm and stored under the sock elastic. It wasn't a big deal, those "socks" they hand out when you get the PICC are a joke.
I tried this with socks but found they were just too loose so I did a similar thing but I bought Vetwrap which is a kind of bandage that sticks to itself but nothing else. I got it in a bunch of different colors so I could color coordinate! (I'm young and even younger at heart! ) I learned about Vetwrap from the mother of some young girls who were on IV antibiotics and it was great and really helped to de-medicalize my 6 months with my PICC line. Now, of course, my de-medicalization process for my IV stuff involves naming everything (my port is Winnie the Port and everything else has a fun name, too ).
Peace and healing, Annie
Posted by trueblue (Member # 7348) on :
![[Smile]](smile.gif)
)
![[tsk]](graemlins/tsk.gif)
![[Big Grin]](biggrin.gif)
).![[hi]](graemlins/hi.gif)