Tomorrow I'm finally getting in my Hickman IV line for my abx treatments. I'm having a moderate amount of anxiety over the procedure and was wondering if anyone could tell me their experience with a Hickman line.

This is what I know...

I will be sedated for the procedure. The line goes into my neck and the exit point will be where my clavicle, pectoral muscle, and shoulder meet. (If you hunch your shoulder forward there should be an indent and that is where it will be). I've been told that the only pain I should feel is when they numb the area and then should only feel pressure after that.

My heart is pounding as I write this post. I'm excited to go on my Rocephin abx, as I have felt wonderful doing them on a limited basis weeks ago to trial it. I'm just very concerned about what to expect from the Hickman line.

I was also told this is better than going in my arm since the Picc line in the arm is difficult to live with because of limited mobility and such. I can do anything with this line except swim or take a bath. I can even excercise with it if I feel like it.

Any advice or kind words would be VERY appreciated!

Best,

Julie

as alwasy remember its YOUR choice even if you have to change Drs!!!

http://www.planetcancer.org/forum/viewtopic.php?t=3081

I havent personally had anyof them but my kid, 19, faces the decision soon and we may go with a Portocath due to less complications

and scroll here to CHEMOD for a pic--his hickman is on left with TWO tubes hanging ( some have tinier tubes nearer the neck) and his PORT on the right ( his left) the disc under the skin

http://www.planetcancer.org/forum/viewtopic.php?t=3081

good luck and let us know how it all goes!!!

Finette

I got my Hickman in on Wednesday, and it went great!

I went into the Hospital and they put me on an IV in my arm to give me an abx for the procedure.

I then went into the Cath Radiology room and was put on the bed and given oxygen and met the x-ray tech and all the nurses there.

After my doc came in to talk to me, they gave me my first dose of sedative, a valium/morphine mix. Yay! I was feeling pretty happy at that point!

The doc had to numb me with local anesthetic at the entry point (base of my neck) and exit point (my chest above my right breast) and that hurt a bit (prick and burning) so I asked for more sedative and got it since my vitals were okay.

Basically I talked to the doctor and nurses the whole way thru and didn't feel anything (I ended up getting 3.5 doses of the sedative thru the procedure). I barely remember anything, although when it was over I called my doctor a bad ass mo fo since it went so well. Apparently I was quite the comedian!

I am still sore from having the catheder tunneled under my skin from the neck to the chest. I also had an issue with irregular heart beat when I was at home later that night when I lay on my left side or bent over. So I called the doc and he said it was probably in too deep so I went back in and he reopened the stitches and shortened the line so it wasn't touching my heart.

Now I'm back at work and getting my rocephin IV right now! I have two lines hanging out of my chest. One for entry, one for exit (taking blood). The doc said that my body would accept it and my skin would heal around the exit point and that infection would be slim.

The reason they like to use hickman is because the entry point at the neck is stitched closed and where the cath comes out of your chest is in a different location. So the chance of infection getting into your bloodstream is very very low. Plus if it stays clean and working, it can stay up to a year! Like I said in the earlier posts, I can use both arms and I'm not limited! Yay! I never had a PICC line, but I don't think I'd like it. Now that the procedure is done, I'd recommend it!

Fin - I don't have a port like the guy on the chemo website. Just the two lines, and mine are smaller than the man's in the picture. Mine are the size of 2 IV lines.

If you have any questions, let me know!

I'm so thrilled that this is behind me!

Cheers,

Julie

Accounts that give the details of these procedures are SO important for people who want to know what actually goes on. Especially when it went smoothly.

Those that have a bit of trouble with a Hickman should post also, though----- since only through these patient accounts do people really know. (Docs and nurses don't always have to time to 'discuss')

He had the thing put in under local anesthetic, so he was awake for the whole thing. He said it was pretty disconcerting, because you can feel the doc working on your arm as far as pressure goes, but no real pain.

The doctor ultrasounded his arm for a good vein, then made a puncture wound to get to the vein. They thread a wire all the way into the heart, then widen the entrance to the vein. At that point, they thread the catheter in and do fluoroscopy to make sure it's in the right place. The doctor then made an inch long incision about a quarter inch lower towards the fingers than the puncture and blunt dissected out a pocket for the head of the port. Once the head of the port was in place, he tunneled the catheter end under the skin and connected it to the port. J has stitches under the skin on the long incision, everything else got glued shut.

The doc put the end of the catheter actually into the atrium of his heart, saying that he had more success with them when the catheter is a little farther in. Since he wasn't having any weird arrhythmias with the end being there, it apparently protects the sides of the vessels to not have the end banging into them.

He healed up fairly well at first, but then developed a local Staph dermis (resistant to lots, but not everything, thankfully) infection. So after his first week using the port, the home health nurses put in a peripheral catheter to use so he could heal a little better before they went back to using the port.

Unfortunately, having the scab under occlusion from the dressing used around the infusion set forced it back under the skin. He has a cyst that is slowly working it's way out, but it doesn't interfere with using the port. He's almost healed now, though some part of the slowness may have to do with his diabetes. He usually takes a little longer than most.

So he's got a nickel sized head under the skin on the inside of his arm. It sticks out just a little under half an inch. To access it, he gets a Huber needle put in once a week, but then he can give the IV abx himself during the rest of the week. I went to watch the nurse put the needle in last week, so if it's an emergency, I can put it in. He doesn't use it to draw blood from, since that increases the chances that it will clot.

His biggest complaints with it (other than it hurts a bit if I accidentally brush it) is that because it's a direct line to his heart, as he's pushing the saline in to flush it, in less than 3 seconds, he's exhaling it. It feels a little like drowning because of the increase in fluid. I can smell it on his breath- it's pretty chemical-ly smelling, so I'm sure it's not pleasant to be the one it's going into.

His 28th day of IV Rocephin was yesterday, and he felt like hell. I think he's herxing a bit. It's been getting progressively worse this past week- pain, nausea, general brain fuzziness, and lack of energy.

I'm hoping today means he feels a little bit better.

Post edited by: VetNurse, at: 09/01/2008 08:05

Many people do it faster. Some health care nurses don't even mention going slow!!!!

AND many people are still alive after 'slamming' it in. LOL But if you think about it--- Rocephin is a caustic drug. If it's dropped out the end of the catheter near the heart---- it's best to allow the large vessel there to flush that drug away before adding more to the load.

That's how I did it for 17 months. And that's the way most health care nurses train their patients.

FYI

Although some places do it differently, the best way to have a PICC inserted is using Interventional Radiology, which is mentioned above by VetNurse. It is much safer, as the radiologist is able to watch the movement of the wire and then the catheter (which is threaded over the wire, then the wire is removed).

My wife (an RN) didn't want me to go to her hospital to have it done, because they don't use IR. They just locate the vein and insert the PICC, then X-ray to see if they got it right. That sounded scary to me, for sure. My doctor said to use IR, but his office is over an hour from me. Despite that, I took his advice and went to the hospital near him and had it done through IR.

The procedure is more scary due to anxiety than there is actual pain. I've had three of them now, so I have a pretty good idea of what to expect. It has taken less than 15 minutes to do, each time.

I've heard and read several stories about different IV options, and I am not sure if one is better than the other, because they are all an inconvenience in one way or another. But, if we want to get well....

Tom

I also have the pressurized balls of Rocephin, which take about 30-40 minutes to infuse the 2Grams. My IV line also is in the superior vena cava.

I went into the Vascular/Interventional Radiology office at our Local Hospital to have the procedure done. I would be really nervous to have it done elsewhere - but that's just me. I am anxious about needles anyway, that I think having it done anywhere else would TOTALLY freak me out to the point of total panic. Plus having it done at this facility allowed me to get all the good drugs so I wasn't even aware of the procedure!

How is having a PICC line? How often do you have to change it out? How long do they expect you to be on IV Rocephin? My doctor thinks 6 months for me to start, that is why the IR doc wanted me to do a Hickman Line instead of a PICC.

The only thing I'm bummed about is that I'm a female with tubes coming out of my chest above my right breast. Trying to find clothing to cover it but still allow me access to get my IV is a pain, since I typically wear "V" neck shirts or scoop neck - that is most of my wardrobe. Wearing that stuff you can see my dressing now and I don't want to show it. I'm also a little paranoid about scarring after this is all over with. But my husband keeps telling me that he doesn't care and that it's not a big deal if this gets me healthy again.

I'm just glad this hickman can stay in for a year if needed so I don't need to go through all of this again, but hey.... At the risk of sounding like a stoner (I don't do any drugs) I wouldn't mind getting the Valium/Morphine mix again.... that kinda rocked and was totally legal!

I'll see if I can take a picture of my hickman and post it soon. In case any of you are interested in seeing it.

Have a great day! Hope everyone feels good today.

A PICC line is a total pain (to have in), because I can't get it wet, so I have to wrap it with plastic before every shower. It's also been great working on my pool all year, and not being able to get in it and enjoy it (he says, with sarcasm dripping all over the place).

I had my first PICC in from Feb 13th to March 13th. It got some gunk on the outside of the tube, about 2 inches up from the entry point, and blood started to come out of the skin opening. It wasn't hurting me any, but that much blood is just asking for an infection, so we had it pulled. Four days later I got a new one in my other arm. It clotted in one day, so I had that pulled. They had to wait about two weeks to try again, so I had my third one in on April 1st, and I've had it in ever since.

The general wisdom is that PICC lines only last a month, but that's not true. My nurse has a patient who has had hers going on two years! I don't want mine that long, because to me, that means the treatment is not working. My doc agrees.

I have had only minor relief for the five months I've had it in, but it takes longer for some. I have had the dizziness and light-headed feeling go away, but that has only been in the last two weeks. Except for some minor jaw and neck pain, nothing else has improved.

I had an appointment last week, and my doc wants me to discontinue the Rocephin for now, and see if any of my symptoms return. He feels the IV has run it's course, and he wants to continue to attack the Bartonella and Babesia, which he believes is my biggest problem right now. I am starting two new oral abx for these. I don't doubt what he is saying, because I think I should have seen much more improvement by now. I am keeping the PICC line in for another month. If my symptoms don't return, then we will take it out and continue treatment with oral abx. If I get worse, we will probably start another type of IV abx.

So far, I feel like the dizziness wants to return, but it seems to be holding off. I'm keeping my fingers crossed.

By the way, has your doctor started you on Actigal? Rocephin has the bad habit of forming crystals in your gallbladder, and Actigal should prevent it. Unfortunately for me, it didn't, but it isn't the fault of the Rocephin. I am meeting with a surgeon next week to schedule a time to remove my gallbladder. I have quite a number of stones in there now.

Gallstones can form for several reasons, and I have one of the bigger reasons; high cholesterol. I think that, combined with the Rocephin, is what caused mine to form. My GI doc said that Actigal should have prevented the stones, but, oh well.

Hey, in my book, a gallbladder is worth the sacrifice, if I feel better.

Another thing my doc told me that was very interesting...the gallbladder is a harbor for many types of infections. He said several of his patients have felt much better once it was removed. Here's hoping I'm one of them!

Tom

Sounds like you had quite the initial ride with your PICC line. Glad to hear that the 3rd times a charm in your case. Sucks you can't get it wet. I am able to get my Hickman wet, but can't swim/bathe. So when I shower, I just remove the wet gauze, dry the area, and put new gauze on. I couldn't get it wet for the first week and that was a nightmare with plastic wrap and tape. I'm SO happy I don't have to do that anymore.

My symptoms are pretty much purely neurological at this point. The lightheadedness, forgetfulness, word block / search, difficutly at times with speech (when I want to say something urgently it doesn't always come out right. Although, I am still generally tired and lacking in energy. The only pain I have is really in my feet. They are always tight, but it could be because I wear heels to work M-F.

My joint and muscle pain, headaches, have greatly improved and/or gone unless I'm premenstral or having herx. That's why I'm so optimistic with the Rocephin, I really have gotten much better. My lyme tests are MUCH better, only being positive on 2 bands.

My doctor has prescribed Actigal. I've been taking it, so hopefully I don't get any gallstones. But, my mother and grandmother have had both theirs out and seem to be fine without it!

I'm optomistic hearing about your lightheadedness/diziness going away with Rocephin. That's my biggest gripe! If mine goes away I will be on cloud nine!

I agree with focusing on the Babesia. We didn't really treat my lyme until I got rid of my Babesiosis. I finally kicked it with 6 months of Mepron, 1 TBSP 2 times a day. I didn't think it was so bad, but have seen other opinions on the forums. I actually kind of liked the taste. I believe I was also on Azithromycin 500mg 2x a day during that time. It's hard to remember all my combos of abx! I felt SO much better just getting over the Babesia. Plus getting rid of the Babesia and/or Bartonella will give your immune system a little bit of a breather which will also help fight the lyme.

I would knock it out one at a time, otherwise it may feel very overwhelming! Plus abx for one will help treat the other co-infections as well.

Best,

Julie