Saturday 1 February 2014

How was the hickman line issue resolved?

During the eighth ECP treatment was when an issue with my hickman line was discovered, but, to quote one of the nurses, despite trying me in more positions than in the Kama Sutra, drawing blood from it was still far more 'miss' than 'hit'. The rationale behind waving my arms around, turning my head, laying down, taking deep breaths, coughing and so on was that sometimes the hickman line can get into a position where it's problematic for drawing blood, hence by taking such actions things can move around a little, which may result in the hickman line starting to work.

Note: If you imagine the hole(s) in the hickman line being close to/up against a vein, the sucking action of trying to draw blood can result in those hole(s) being plugged with the wall of the vein, thereby preventing any blood from being withdrawn.

Another issue that can occur is that the hickman line can become blocked, as a result of blood clots, either within the hickman line itself or at the entry/exit points in the vein. When there is suspicion that a hickman line might be blocked, a small amount of Urokinase can be pushed in, and left there for (at least) forty-five minutes. The Urokinase is pretty much the hickman line equivalent of a drain cleaner, in that it hopefully breaks-up/dissolves any blood clots, thereby unblocking the hickman line.

In my case, there were no issues with pushing fluids in, hence it likely wasn't blocked within the hickman line itself, but it could potentially be blocked at the entry/exit points, as sometimes the blood clots over the hole(s) in the hickman line and acts like a one-way valve, i.e. pushing fluids in opens the valve, but trying to pull fluids out closes it. In some ways, it's very similar to how the wall of a vein can act like a plug.

Note: Trying to push/pull any fluids in/out of the hickman line can often be enough by itself to clear any blockages, as the pressure caused by doing so is sufficient to dislodge them; That's why a few techniques of applying sharper bursts of pressure than usual (due to concerns of causing damage) are sometimes attempted.

Unfortunately, despite a few attempts at using Urokinase etc, my hickman line still only worked intermittently at best, hence the next step was to go for a lineogram. A lineogram essentially involves the use of contrast fluid and x-rays to check the positioning of, and see what is happening with, the hickman line. If the hickman line needs repositioning, it is sometimes possible to do so, but it tends to depend on how long it has been in, as after so long they are pretty much stuck in place. If the hickman line needs unblocking, it is sometimes possible to use a thin wire to clear any blood clots that the Urokinase was unable to break-up/dissolve. If all else fails, then the only option remaining is to remove the old hickman line and insert a new one.

When I had my lineogram, all of the preparation for replacing the hickman line also took place (just in case), i.e. surgical sheets were positioned as necessary, the area where the hickman line would be removed and inserted was cleaned with an alcohol solution, and so on. It should have occurred to me really, but the combination of dry skin, caused by GVHD, and alcohol solution, for cleaning it, is the perfect recipe for some pretty unpleasant burning/stinging sensations! After that, any local anesthetic would have seemed like a walk in the park. Fortunately, even though my chest and neck felt like it was on fire, the thin wire managed to unblock my hickman line, so I didn't actually need to have it replaced. Having said that, a few hours later, when a nurse tried to take some blood samples from it, it was back to its intermittent ways! Unfortunately, that meant the old hickman line coming out, and a new one going in. However, it was Christmas Eve, so that pleasure was saved for another day.

The timing of my lineogram actually reminds me of an amusing story. As is often the case in hospital rooms with imaging devices, there was air conditioning to prevent the equipment from over-heating, and that meant it felt pretty cold in there, especially as I had to wear one of those thin hospital gowns. Consequently, whilst waiting for the lineogram to begin, I was wrapped-up in some blankets to help keep me warm. One of those blankets was a space blanket, i.e. what looks like a large piece of tinfoil. As you might imagine, it wasn't long after being wrapped-up in the space blanket before I was being compared to a Christmas turkey. All I had to say was: I'm not sure how many x-rays it takes to cook a Christmas turkey, but if I see anyone come anywhere near me with sage and onion stuffing, I'll be out of here quicker than you can say Paxo!

On New Year's Eve, I had my old hickman line removed, which was nothing to worry about really; I only felt some burning/stinging sensations from the alcohol solution and local anesthetic, even though the doctor did have some fun with a scalpel trying to remove the well knitted-in cuff (designed to hold the hickman line in place). A couple of days later, a new hickman line was inserted, which was also a non-event really, even though it also meant yet more burning/stinging sensations from the alcohol solution and local anesthetic. The end result was that my chest and neck was decorated with dressings, as you can see in the photo below (click on the photo to see it full size):

Hickman Line - Insertion & Removal - Dressings

1 comment:

  1. Never a dull moment in your treatment is there....I know, you'd love to have some "dull" time wouldn't you.

    Thanks for the update.