Monday, 2 July 2012

Draining a Pericardial Effusion (Fluid around the Heart)

Once I arrived at the Cardiac Monitoring Unit (CMU), I was connected up to a heart monitor (just like with an electrocardiogram) by one of the nurses, and a doctor came and performed a quick echocardiogram to see how best to insert the drain.  The doctor asked one of his more senior colleagues to join him, after a quick look with the ultrasound scanner, as it turned-out that the normal entry point for the drain wouldn't be possible, as the path from there was obscured by the cancer, so instead of going in the centre of my chest (just below where the bottom of the left and right rib cages meet) it would need to go in my left side (between the ribs at a similar height); Once that had been decided, I was moved down to the Cath Lab to have the drain inserted.

The Cath Lab looks pretty cool, a bit like something you'd see in a sci-fi movie, as there are: panels of monitors, an x-ray machine that hangs from the ceiling (it can move around the room on tracks), and other assorted gadgets; However, it did amuse me that with all of that technology, the biggest problem was arranging it so that I could lay on the bed at around a 45 degree angle; there was an appropriately sloped cushion that I could lay on, but it would just gradually slide along the bed, so in the end, after trying a few things to hold the cushion in place, the not so high tech solution was to sticky tape a bag of saline solution to the bed so the cushion couldn't slip past it!  It was at this point that the Cath Lab lost some of its cool sci-fi look and feel!

Armed with the sticky taped bag of saline solution, the drain could now be inserted under local anaesthetic, and other than feeling the local anaesthetic going in, which is just a slight stinging sensation, I never felt a thing; To be honest, I wasn't even sure when the procedure actually started.  The drain itself is nothing special really, as it's just a thin tube that is inserted in to the pericardial sac (a wall of tissue around the heart), so that the fluid can slowly drain by itself over a number of hours into a bag connected to the other end.  I did seem to have a bit of an audience in the Cath Lab, as I got the impression a number of people hadn't seen it inserted in that position before, and I think it was even the first time the doctor had inserted it there too, as one of his colleagues explained the process to him in detail.  Anyway, once a sample had been taken for analysis, and the area had been cleaned and dressed, I was back on my way to CMU.

In CMU, I was reconnected to the heart monitor, and placed on bed rest whilst the fluid drained.  The fluid drained relatively quickly at first, i.e. most of it came out within a few hours, but the drain is left in for longer to make sure the fluid stops coming; I'm not sure what I was expecting, but the fluid looked a lot like a urine sample!  In fact, even one of the nurses confused it for one, as when I asked about going to toilet, she brought me a bedpan, and when I then awkwardly explained that that wasn't what I was meaning, she looked at the bag of fluid and started saying "but..."; Incidentally, it turns out that peeing in a bottle when you are not allowed out of bed is not all that easy, so I'm glad I didn't need to use that bedpan!

About the only thing you can do in CMU is try to filter out the noise of the heart monitors going off all of the time: It seems like the sensors are a bit sensitive, so when people move around the heart monitor loses the signal and starts bleeping to alert the nurses that it can't get a reading - the nurses know which bleeps to listen out for, and mostly ignore the others.  The heart monitor was going off quite a bit for me, as my pulse is a lot higher than normal (due to the cancer it seems): even at rest it is around 120bpm, whereas it should be more like 70bpm; unfortunately, the heart monitor bleeps like crazy when you reach about 130bpm, so all I had to do was move around a bit, e.g. try to sit up slightly to go to toilet, and off it would go!

My response to the drain was fairly typical really, as the area around it ached a bit after the local anaesthetic wore off, and I also later got what is known as pericardial rub, which is when the heart rubs against the pericardial sac and causes some discomfort, presumably until the body adjusts to the new levels of fluids around the heart; At first, I was given some paracetamol for the discomfort, as it was just enough to stop me from sleeping, but that didn't really help, so I was then given some ibuprofen and that - or just being even more tired - helped me drift off to sleep.

The morning after having the drain inserted I was allowed to move around a bit, so I went to the bathroom to get washed etc, albeit still connected to the heart monitor, which was obviously bleeping like crazy for the duration; a nurse did ask if I was alright, but although my pulse was pretty high, due to moving around a bit, it was only about 10-20bpm above my resting heart rate, so I was fine really except for being a bit out of breath.  Shortly afterwards, a few doctors "doing the rounds" turned up, had a quick chat with me about removing the drain later on in the day, and listened to my heart; The most senior doctor among them was keen for the other doctors to listen to my heart, as it apparently had quite an interesting sound, due to some inflammation.

Later that morning, a nurse disconnected me from the bed-side heart monitor, and connected me to a small wireless one, which you can easily carry around (in a not so stylish man bag); when I say wireless, I mean it wirelessly reports your heart rate etc to the nurses station, i.e. it still has wires connected to your chest (it's not that clever).  The small wireless one was a lot better to be fair, as it meant you weren't stuck in bed, unless of course you were worried the man bag would do too much damage to your street cred; that was something I didn't really have to worry about, because as bad as the man bag might look, carrying around the bag from the drain had pretty much already put the final nail in that coffin!

The drain was removed late on in the afternoon, after a doctor performed another echocardiogram to check all of the fluid had gone; The doctor asked how much fluid was drained in the end, and I could tell just by the look on his face when I said about 850ml that that was a lot - I asked the doctor how much fluid is normally around the heart, and he said about 10-20ml, so it was obviously quite a bit more than normal!  The removal process itself is pretty simple as they essentially just remove the dressing, slowly pull the tube out (it is surprisingly long), and finally redress the area; No anaesthetic is required for the removal, as you don't really feel anything, so if you had a local anaesthetic that would most likely be the worst part.  Once the drain is removed, your time at CMU is over; All that is left is for you to remove the dressing in a couple of days, and it should heal-up fine.

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