Tuesday, June 15, 2010

PICC insertion

Because my oncologist was in a hurry to begin my chemo treatments, he ordered the insertion of a PICC (Peripherally Inserted Central Catheter) immediately. Then, given I was going to be receiving infusions for a year (chemo followed by Herceptin), I would have a port surgically implanted at a later date.

A PICC is inserted in the arm opposite the breast with cancer. The tube is inserted in a vein in the arm and advanced through increasingly larger veins until the tip comes to rest near the heart. A tube extends from the underside of the arm, above the elbow, and the chemotherapy drugs are infused through that tube. By infusing the drugs almost directly into the heart, the toxic chemo drugs do not damage the veins in the patient's arm, a significant concern with long term chemotherapy. Instead, they travel immediately to the heart which flushes the drugs into the body quickly with little damage to surrounding veins. In between treatments, the tube is covered by gauze and plastic dressings. Home care nurses monitor the PICC, flushing it freqeuently to ensure the line is clear and monitoring the entry point for signs of infection.

Given the stressful event that was my surgical biopsy, I was worried about the PICC insertion. I needn't have.

The wonderful woman who would be inserting the PICC was gentle, clear and informative. She guided me through the procedure using diagrams, checking often to ensure I understood what would happen. She also outlined aftercare and how I would need to adjust my life to accomodate the PICC. I would not be able to lift anything heavier than 5 pounds, so she ran through ways I would have to adjust how I managed my two young boys.

Then she gave me advice that, at first, shocked me. But in the months since then it is advice that has helped me again and again. It was bad, she said, to hold my breath. Holding my breath would put too much pressure on the PICC tube and could cause problems with it. "When you need to cry, you must cry. Don't hold it in." She locked eyes with me and did not look away until I had nodded. This was the first health care professional who had acknowledged that crying...fear...sadness...would be part of living with cancer. It was a remarkably empowering and moving moment.

Then I put on a gown, was settled on the bed and  met the nurse who would be assisting. And we were off. First up, "What do you think? You look like a Nora Jones person. How would that be?" Are you kidding me? With that, the stereo was turned on, the lights were dimmed and we were underway. It took most of the album to complete the procedure, but it was painless and stressless. Compared to the surgical biopsy, it was like going to the spa. (And for, like, a happy procedure like a scrub or massage rather than a bikini wax.)

The after care was the problem. Because chemotherapy is very hard on your body, you can develop skin sensitivity. This happened to me. Never one to have any skin issues at all, I was dismayed to learn I had developed a sensitivity to plastics and latex. The plastic dressing over my PICC led me to break out in a dreadful rash. The nurses needed to replace the plastic dressing with gauze and paper tape and I needed to be vigilante about the use of any more plastic dressings during any form of treatment. Other than that, the main concern was keeping the dressing dry. I could not shower or bathe without covering the dressing with plastic. Typically, I used (and reused) disposable plastic shirt sleeve protectors, purchased at a local Japanese dollar store, Daiso. Sort of like a gator for your shirt. I also used plastic bags, opened at both ends, along with elastic bands and additional tape to ensure a tight seal.

Living with the PICC was not a huge challenge. But it was inconvenient. It is very hard not to lift your children, laundry or groceries. Pretty significant shifts needed to happen in my home. I could not do yoga, swim or bike ride. Sleeping was really uncomfortable. And the rash made my arm sore. There was a significant concern that the rash could lead to infection. Luckily it did not. But I knew there was no way I could do the entire year's worth of treatment with the PICC.

And luckily I didn't have to.

Up next - port insertion. :-)

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