The Hickman Catheter (there are pictures!)

It was pretty bizarre when Steven had his Hickman Catheter inserted at the end of September.  This long line hangs out of your chest, can't get wet, must be flushed with heparin every day, and it's dressing must be changed every week.  Life saving units of blood in, many weekly blood tubes out.

I don't remember when he actually got used to it but we are grateful he doesn't need it any longer.  When the lines hung, they ended at his waist.  At COH, they had a special clip that attached it, coiled, to the collar of his shirt.  When Steven was discharged, they showed us how to coil it and tape to his chest.  That worked until his hair started growing in :)  So instead of taping it, Steven decided to let it hang.  What a great idea until a nurse thought it had pulled out a little...back to the clip.  Who knew?

I was pretty methodical when changing his dressing, 100% Type A.  We have a small table that I alcoholed and covered with a clean cloth.  After laying all the supplies on the table, each item was prepared (air out of syringes, containers opened, etc...).  

Gloved and masked, I worked on taking the dressing off with an adhesive remover, being careful not to push too hard where the line runs under the skin.   

The disk over the insert point is called a Biopatch.  It is imbedded with chlorhexidine (CHG) which continuously suppresses the growth of bacteria on the skin.  Without this protection, bacteria will immediately repopulate possibly causing infection.

With the Biopatch removed, you can see the stitches that keep the line from falling out.  There is also a "cuff" under the skin inside the insertion point.  When they talked about a cuff, I imagined a disk like object because, after all, there has to be something in there keeping it from falling out! At this point, hands are washed and regloved.  The area is cleaned with Chloraprep (iodine based) being careful to work from the stitches outward.  A thin film of skin prep is wiped where the new dressing will be.  A new Biopatch is laid with Tagaderm dressing covering the area.  But wait there's more!  Now the tips are changed.  A tip is removed using alcohol on a gauze pad, more alcohol, a new tip, more alcohol, saline flush, more alcohol, and a heparin flush. Smile and repeat for the second tip.  This was a Reader's Digest version but you get the picture.  

We had to schedule his Hickman removal...outpatient procedure.  I was thrilled to be able to stay and see the procedure.  The nurse practitioner explained the procedure, papers were signed, the site was draped/prepped and a local anesthetic was injected around the insertion point.  The nurse was explaining that sometimes the lines are hard to get out, especially when they have been in this long.....great.  Apparently the catheter can become attached to the wall of the vein (all Steven could think of was the quote from Pirates..."part of the ship...part of the crew").  She picked up a scalpel at one point and I backed away from the table.  

Eventually she pulled the mother of all lines out.  See the small red area on the catheter?  That is the "cuff".  Good heavens, not what I expected.  It was almost like a piece of gauze.  If we had known that was the only thing keeping his line in, I don't think we would have ever let it hang!  

It was a longer line than we realized.  So awesome!  The last thing I remember is the nurse using a scalpel...I'm thinking Steven will need stitches.  Nope.  They put a bandage on it similar to the Tagaderm dressing.  It couldn't get wet for 48 hours and then we could take the large dressing off and put on a band-aid.  One more step towards normalcy...

Day +204-Day +218

Today is a big day, another milestone.  Steven has had his blood drawn through his Hickman catheter for the last time.  He is scheduled to have it removed today.  You would think we are dancing a jig but it has become an old friend...literarily a part of him.  It's part of our routine to flush every day with heparin and change the tips and dressing every week.  Since he hasn't received a unit of blood for 3 months, it is time to have it removed.  I think I already mentioned that most patients have their line pulled around 100 days, the magical number that betrayed us.  We got to wait twice as long as most patients to see any kind of results...Murphy's Law.  The transition of blood type was the sticking point but fortunately we are there and no worse for wear.  Did I mention the Hickman is inserted into the superior vena cava, direct flow to the right atrium of his heart?  It's time to get rid of it and the infection risk not to mention how nice will it be for Steven to not have to put the line in a baggie and tape it to his chest when he takes a shower.  It couldn't get wet...weren't you wondering why we haven't been to a water park???  Going forward, he will have his blood drawn like the rest of us.  He was getting very hard to draw before the line was inserted in September, but that may have been because he had minimal platelets, WBC's and RBC's.  He has had his Hickman since the end of September and it is time to say goodbye!

Clinic visit went well but Steven has had a lot of nausea this past week.  They will keep his meds the same and gave their blessings to have his Hickman removed....although they thought about it for awhile.  He most likely has a little GVHD and they were concerned with dehydration.  Steven was given his marching orders to increase his nausea medication and we have to come back next week...bummer.

We were here 1/2 hour early so naturally they took us 1/2 hour late for clinic which made us 1/2 hour late for our Hickman removal.  I got to watch them remove it...so cool.  I will post awesome pictures in a separate post.  If you are squeamish or don't dig medical pictures, you can skip that post with the rest of the humanities majors. :)

It's National Nurses Week and we brought donuts/Nothing Bundt cakes for our nurses at the VAD draw center and at clinic.  The nurses at City of Hope are stellar, top notch professionals.  I can't say enough about them and how amazing they have been through this entire process.  From fighting...I mean speaking with our insurance company, to helping us get our Hickman supplies, to listening to our concerns (whining), to all the reassurance and compassion, they have been with us every step of the way.  Thank you!!