I also am wondering about the protocol I am on.. I;m not sure I understand why I am on 4 days on with 3 days off. Wouldn't the antibiotic (Rocephen) leave the body by then. I was thinking of calling the Dr and asking for 7 days...

Kind Regards
Jeannine

I have had a few picc lines and have never encountered what you seem to be experiencing. I would suggest you contact whoever put it in and or your doc. I have never pulsed rocephin either...it was always every day of the month sometimes for two months at a time....

As I said, I am just a few days ahaed of you with my PICC.

First, if the PICC is a different length now, call your infusion service or doctor. The PICC is supposed to saty at the same place so that it is optimally located in a blood vessel, but not in the heart.

They should have measured the length outside when inserting it. This info should be in your records for them to compare. If it has in fact slid further in they need to adjust it, and anchor it more securely.

Mine is only anchored with steristrips and the tegaderm, but as far as I can tell it has not shifted.

As far as blood, I have had a fair amount of blood still. However, there was only fresh blood when the dressing was changed last week. Since we can't wash the site, it will stay till the next dressing change. I don't think dry blood is a cause for concern.

I also had MUCH more pain than I was told was likely. This was not herxing pain, but pain from the insertion. I have very small veins, and lymph and blood drainage problems in the whole neck, shoulder, and arm area.

I think the insertion caused damage and swelling that triggered off a bad flare of this condition. I had to take extra Vicodin for ten days following the insertion because of pain in the neck and arm.

Again, this was NOT herxing, but the exact pain I always get with this issue. I had herxing TOO.

Everyone is different in how their body tolerates things, and what will set them off. I didn't know anybody else that had as much pain as I did. And I have high pain tolerance.

I also don't know anybody else who had as much bruising as I did. It was pretty spectacular, and with three tries on the insertion it was everywhere.

My nurse told me that as long as I could see bruising, the interior healing was still going on as well. Two weeks later it is still there, but the pain is much less.

Definitely get them to check whether the catheter has slipped in. That should be an urgent priority, though maybe not an emergency if it is not causing problems.

Ask about the rest, but it may be normal healing. I have much less trouble than even a few days ago. Hopefully you will soon be doing better too.

The other issue is once that part of the PICC is outside of your boday it is no longer considered sterile. The part of the line that is inside your body-right past the insertion site is considered sterile.

So if the PICC migrates back in, there is a potential for infection. Just check with the doctor or home care nurse. If the dressing was intact at least the PICC was covered. You should have someone change the dressing too. They might decide just to pull it out 2 inches and someones mentioned stitches which is a good idea to prevent it from going back in.

Sometimes if they know the line is too long when they place it(by x-ray) they can leave the sheath in (the part they guide the PICC into and then tear away), cut the PICC to the right length and then reinsert it. The sheath keeps the access to the vein so no need for more needles, the PICC just slides in and the sheath(like a hollow tube larger then the PICC) is just pulled apart and the PICC is left in. This is how all PICCS are put in anyway.

I don't mean to worry you, it sounds like you are doing a good job with your PICC. Just run it by your doctor tomorrow and see what they say.

Thank-you for your replies. The nurse came yesterday and changed the dressing and pulled the PICC back out 2" They did do a chest x-ray when they first inserted it and that is how they knew it was to far in. She put Steri-Strips on it to hold it in place. She told me although the area had lots of blood it was normal and looked fine.

Interesting point with regards to the sterile vs non-sterile part. Once it comes out and goes back in not being sterile. Hmm.. I'll have to inquire about that. I start back on them today for the next 4 days and then another 3 days off.. aghhh.. I find the synringes that the medicine comes in extremely hard to administer. It takes all my might to push the plunger and get the 2g's into my system.

Does anyone else do this while being alone at home.. Just wondering with regards to something happening if something was to happen.

I also found it strange yesterday that they have a "runner" from the pharmacy drop off the meds. kind of scares me knowing they are syringes that have medicine in them. I would think the nurses would bring that stuff over.. oh well.

Have a good day.
Kind regards
Jeannine

I did my own infusions at home. I would go to an ambulatory infusion center (at my Dr.'s office) once a week to have the bandage changed and to have my blood drawn for a CBC and a liver panel. I would pick up my meds and supplies there.

Like River, I had lots of bruising the first time and also lots of pain in my chest area.

My Picc was too close to my heart the first time and I had palpatations and skipped heart beats. That first line was pulled and replaced.

The lined should be inserted through a plastic plate that is sewn to your arm. The line is then taped into place just below the plate. If done properly it should never move in and out, unless you really yank on the line.

The dried blood is ok. Your nurse should be able to clean that up.

I have been on Rocephin twice and did not pulse either time. Although my herx schedule was pretty much every 28 days, my MD felt it was important to keep the Rx in me 24/7 to be sure we hit the buggers every time they woke up for breakfast. It was not easy. I felt pretty sick at first but, it did get better.

Just curious, why did they take a chest xray afet the fact? Didn't they have 2 monitors on the entire time during the insertion? One is like a sonogram or ecco that watches the heart and arteries. The other is an xray video camera that shows the position of the line while it is being inserted. These would show them if they are too close to the heart or if the line is too long during the procedure.

I would call your nurse and/or MD to ask about the 2". It really shouldn't have gone back in, without being sterilized first.

Her first one just fell out when she had been sweaty and the steri strips got wet..The Dr said it should never go without a stat lock at the end.

We also had a valve problem and possibly the passage of 3 air embolisms.They can be life threatening. Make sure the clamp is always shut after infusing..Do not fall asleep when infusing and check for redness and swelling at and above the site.

Also for showering, she has found that the new glad press and seal over the arm and then taping the ends is wonderful..

Good luck..We hope to go back to one soon but are on a regular IV line currently while she pulses for 4 days..I take it out and then the nurse will put a new one in next week.

Sometimes they only use video xray aka fluroscope (live x-ray) for patients who for some reason have problem with PICC placement.Sometimes they need to inject a liitle dye or contrast to see where the veins are and if the are not blocked. Stenosis, small veins etc. Usually ultrasound is enough. This is why they do a chest x-ray after insertion if they don't use video x-ray- to check placement. Ideally if the PICC is too long on x-ray they should take it out right then and there, cut it and place it back in so it is the correct length and stitch it in. This way you don't have to keep track on how much length is out, because nothing sould be out except the hub part, it shouldn't migrate unless the stitches come loose, and when you change dressings it is much more secure. Most important the sterility is more easily maintained.

If you can by with just using ultrasound with insertion you are better off because of less exposure to x-ray. And if they do use video x-ray and it is a child or someone of child bearing years you should ask them for a lead shield(like at the dentist) to protect reproductive organs.

If the PICC had slipped out it cannot be resterilized and put back in. It should be secured at where it slipped out(steri strips) and if it is out more then a couple or inches should be exchanged-much easier then insertion.

It is not unusual to have a runner deliver meds. Always check the syringe to make sure it is the right med, right dosage, not expired and has your name on it. Any questions at all about this and you should call the pharmacist. You can also call him regardind the difficulty with the syringe, maybe he has some ideas.

The rest of the time the clamp just hangs loose.

I have also had small air bubbles in the tubing. The nurse said that is fine. Larger bubbles, they said could be puled back with the syringe, but usually isn't necessary.

I keep seeing people say to keep the line clamped, and wonder if that is because of different valves, etc.?

As for the x-rays (flouroscopy)? I thought the number I had was unusual. At least 10, with several held to run live while the PICC was pushed in. Sounds like maybe it wsn't so unusual, from what others are saying. It just seems like a lot of radiation, especially in the thyroid area.

Any thoughts on that?

Just wanted to put in my two cents about the pulsing. I did pulsing the same as you with four days on, three days off. But, I was doing one gram twice a day instead of two grams once a day. Some doctors do it this way in hopes of reducing complications and to keep a more constant dose in your body.

The pulsing is used mostly to prevent complications, gallstones (which I unfortunately developed when I was on it a few years ago - not pulsing - and had my GB removed), and other side effects. It also may hit the bacteria harder because it isn't a constant level. When the level is constant, the bacteria may go into a cyst form where the medicine can't get to it. So, by pulsing, it may prevent this from happening and therefore kill off more of the bugs.

Hope you get the PICC line stuff figured out! I have a port now (it's not in use now, awaiting going back on treatment sometime in the next few months) and I really like it but I had a PICC for six months in 2002 and it worked fine for me. I found a great product for showering. It's called a Xerosox and basically it looks like a big blue rubber mitten. It goes over your arm, up over the PICC line site, and then you pump a little thing in it and it pumps all the air out of it so it's an airtight seal. I even used mine to go swimming a few times and it worked great! Very durable, will last a very long time (mine was still in great condition after six months). You can find them at www.xerosox.com or by searching the web.

--Annie

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In answer to the clamp question, with my PICC, which had a safety valve, I always keep it clamped. This way if something were accidently happen and the line became open to air you would be protected. This way it is less likely to get an air embolism or infection should the line become open. But this is me, I am cautious. The major problem with keeping the clamp on all the time is remembering to unclamp when flushing or insfusing! A few times I would say why isn't this flushing and realize the clamp was on!

And it does depend on what kind of valve, some people might not have a luer lock or other safely valve so they need to keep it clamped. But I think it should be clamped for safety regardless. Also helps prevent blood from backing up in the catheter.

Little air bubbles are ok. Like the nurse said you can try to pull back larger ones with the syringe, but be aware that if you pull back and don't see blood coming back you are just sucking more air. You should pull back until you get blood return in the syringe and then flush as per protocol. If you are unsure about the bubbles just call the nurse or doctor. An air embolism is much more likely to happen if arteries were used, not veins.

Great topic of interest. I have the nurse coming again this afternoon to redress the PICC. I had to do it myself yesterday after she had done it on Monday.. She put the steri-strips to close to the opening and it was killing me. When I called the infusion company and told them I changed it, they said they were going to send out a nurse to do it again.. Agh..

I still question the 2+" of excess catherdar hanging out. I like alot of you feel as though they should snip it or put one in the right length but I am told that it is not a problem as long as it is taped down good. Seems like a pain to me.

I also took the liberty of ordering one of those Xerosox. What a pain taking a shower with this thing even more so when you have a full head of hair :-)..

Anyways. still progressing on week 2. 2g's of Rocephin, Nystat 3xdaily and the good bacteria pill 3x nightly of course that is only the lyme treatment meds..:-) I'll keep you all posted. Thanks again for all your support.