[posted Tuesday, after John said no more reports till Sunday]
A continuation of the drip, drip epistle: We’re good at prematurely speaking about successful activities. For my blood draw and infusion today, at 3:00 p.m., we found that the the PICC line would not flow, unlike the water line at home that won’t stop. There was not a drip of blood to be had because there was a clot in the line acting as a stopper and wouldn’t allow anything by or from. The first saline solution seemed fine, but subsequent attempts to draw blood resulted in dry air. This normally is just over an hour in and out for the antibiotic infusion. Not today.
The problem would have been either a fibrin tail or an intraluminal thrombus.
These and other PICC issues are reported here:
http://www.medscape.com/viewarticle/508939_6 Here are quotes:
#1 “Fibrin also may build up on a catheter without completely enclosing it. In this scenario, a small piece of fibrin hangs off the catheter tip. This is known as a fibrin tail, which also represents a persistent withdrawal occlusion. These can sometimes be resolved with an infusion of low-dose alteplase over 2 to 4 hours, but this is not always successful, and the fibrin tail may develop again.”
#2 “An intraluminal thrombus forms inside the catheter and can result in partial or complete occlusion. It often can be dissolved with a small dose of alteplase, a fibrinolytic agent that is instilled for 30-120 minutes and then withdrawn from the catheter.”
~ ~ ~
When the PICC is to be used the first thing done is to apply suction until blood is seen. When none shows up it indicates a blockage. Fibrin is explained here: http://en.wikipedia.org/wiki/Fibrin
When fibrin attaches to the inner-end of the line or tube (lumen in hospital speak) it floats in the blood stream until that backward flow from the external suction causes it to be pulled into the open end of the tube. If the lump or clump (thrombus) is formed inside the lumen then the condition is called an “intraluminal thrombus” as in quote #2, above.
If you have a broadband connection, try this video for an explanation of these things and the solution. (This is an ad-like video for the chemical used in my PICC.) http://www.cathflo.com/media/cathflo_moa.mp4
The production of this stuff involves recombinant DNA technology, fermentation, and Chinese hamster ovary cells. Why Chinese hamsters? Who knows? We didn’t even realize hamsters had nationalities!
Which ever it was, we had to go to plan B. That meant an extra hour plus while we awaited delivery from the pharmacy of Cathflo Activase® and its forced entry into the PICC line with turbulent motions. Push, push, to get the fibrin broken up and the line unclogged. Meanwhile, John retrieved me a warm blanket to try to get me comfortable. Those 45 minutes seemed to last forever. I called a friend on the cell phone to tell her my plight.
Finally, the time came to search again for blood from the PICC turnip. It came!
First item on the agenda was to draw blood for an INR test, from the PICC. Before that, one has to clean out the Cathflo Activase® and about 10 cc of throw-away blood. (No wonder I’m anemic; they put blood in one week and take it out the next). So we continue. She draws a full vile of blood for the INR test, more than enough to be on the safe side.
I had started the paperwork over a week ago from my family physician’s office to put the INR on tap for being done by a nurse in the Out-Patient Services where I am every day except the weekend. This is a great service that prevents being “poked,” but Lab personal cannot take from a PICC line; only a trained nurse is allowed. When I came in, before she started the antibiotics I mentioned the need to do the INR test and that the paperwork was in place. Normally, I have a standing order at the Lab, but nothing at the Out-patient Services. This nurse couldn’t find anything in the records, so off she went to call my family physician’s office to request it before she could draw. There was plenty of time while we waited for the fibrinolytic agent to work its dissolving wonders.
Once done, as mentioned above, the nurse could change the head on the PICC line (cannot use one through which blood has been taken, and infuse the antibiotics into my PICC. I think it was 4:16 when this part started that usually takes an hour. We were about on schedule, only an hour + later than usual. So begins the drip, drip – one from each bag of the two antibiotics, combining into one tube headed into my superior vena cava — a large diameter, yet short, vein that carries deoxygenated blood from the upper half of the body to the heart’s right atrium.
I slept through the first 35 minutes, but by now my back was hurting, the pillows weren’t right, and I was a basket case for reclining in an uncomfortable set up so long. Oh, I had made a couple more cell phone calls to friends in the set up stages when we were just waiting.
So, I mentioned my discomfort to the nurse. I was in a special bed with remote controls to determine height of back raised and the same with knees. I played with the controls and finally found a good position.
At some point I was really wanting a chocolate milk shake. The nurse overheard me and said they could order one for me. They did.
I managed to rest through the last hour of the infusion. We didn’t walk (wheel) out of there until 6:30. That was 3.5 hours for an expected 1 hour stay. I was not a happy camper. Except I was thrilled to see the double saline solution flushing with a turbulent short pushes motion to force the solution to the line with the hopes of breaking up any clots. I surely don’t want a repeat.
~ ~ ~ ~
In the “for what it’s worth” department: At home, the day started with nary a drip. In order to prevent loss of water from the well John flipped the circuit breaker to the pump; turning it on only as needed to have running water in the house.
A Culligan man was due at 10:00 a.m. but was delayed ½ hour. He got to the house and John explained the problems. They determined the Culligan-Softener (21 yrs old was shot) and the Iron removal equipment was doing fine still. (Ours is ferrous iron that oxidizes in the lines and tanks.) The Culligan-man and John discussed the pressure problem in the tank and decided there was a leak in the house or between the house and the barn somewhere. Turns out it is between the house and the barn but John hasn’t yet located it. He has to dig 4 feet down through alluvial fan material that has been refilled in a ditch for the buried water pipe. He’s hopeful that the leak is in a frost free stand up faucet for the horse tank at the barn. While the exact location of the leak is sought, replacement equipment has been ordered to provide sparkling water inside the house.
Blood and water go drip – drip. Money goes in clumps. Ouch!
Life continues . . .