Friday, January 06, 2006

An Unwanted Journey: Day 0043 - PICC Insertion

It was a long day at the Grand River Regional Cancer Centre, probably the first of many such days.

It all makes sense in retrospect – an early lab appointment for a baseline blood draw, followed by about a 90-minute delay until I saw the PICC line (peripherally inserted central venous catheter) nurse. That time was required for the systemic oncologist to see the blood measures and approve moving ahead with the PICC insertion.

The insertion of the PICC catheter was more involved than I anticipated as well. It required a sterile environment that was novel for me. The PICC nurse had to find a vein that would work; unfortunately mine was on my right arm even though I am right-handed. Thank goodness most of my work is at the computer keyboard. Then, she had to don special gloves, mask, and gown, measure the distance from the vein she had chosen up my arm to a position just above the heart. After cutting the length of catheter required, she had to sterilize the site for the insertion, freeze it with a local anaesthesia, insert the catheter, flush the line with a saline solution (which I tasted almost immediately), followed by another flush with a solution of heparin (which I smelt almost immediately).

After she was assured that I was alright, an orderly took me in a wheelchair for X-rays of my chest to ensure that the PICC catheter was in exactly the right location just above the heart. If it was too long, she would have to cut some off the length; if too short, she would have had to re-measure and re-insert another line. As it turned out, this PICC nurse knew her craft perfectly and had measured precisely what I needed as verified by the X-rays.

I then had to visit the hospital pharmacy to pick up a starter kit for taking care of possible spills as well as changing the dressing and flushing the line. Saturday morning, I will be visited by a Community Care Access Centre of Waterloo Region nurse who will demonstrate the changing of dressings and flushing the line.

One of the things the PICC nurse and I discussed was what activities I can and cannot do during the next 6 weeks while the line is in place. Basically, I can’t shovel snow, I can’t sweep floors, I can’t vacuum the carpet – I can’t do weight training exercises that involve the arms in any serious way. No curls, no lunges, no woodchoppers, no push-ups, no bench presses. My trainer and I will have to adjust the core training regimen somewhat. The squats should be alright as will the sit-ups on the stability ball, the Roman chair knee raises, and bosu squats. I’ll schedule an appointment with a physiotherapist on the system oncologist’s team to ensure I don’t do anything potentially damaging to the PICC line.

Infection is the chief worry. Draining from the exit point that is clear, yellow, or green requires seeing one of the CCAC nurses as soon as possible. Any fever requires an immediate visit to either the GRRCC or the hospital emergency department. Finally, redness around the insertion site could lead to phlebitis, but can be controlled with warm, moist compresses applied every 2 or 3 hours.

Waiting is boring, there’s no doubt about it. But today I was able to read through both the chemotherapy and radiation therapy booklets provided for patients by the Canadian Cancer Society as well as the additional booklet about Caring For Your PICC Catheter from Cook (Canada) Inc.

This weekend is the end of the pre-treatment phase. Monday I start both chemotherapy and radiation therapy.

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