A couple of days ago I had my PICC line at UCLH by two of the most fabulous nurses I have ever had the pleasure to meet and be treated by.
I should probably explain at this point what a PICC line actually is, since I would have had no clue before all this. A Peripherally Inserted Central Catheter (PICC) line is like a permanent cannula, through which all bloods will be taken and all chemo will be administered over the coming eighteen weeks, until it is removed at the end of my treatment. Externally, it looks like two little tubes, or two “lumen”, coming out of my skin at the top of my right arm above the elbow. Internally, it goes from the top of my arm, along one of the main, extremely juicy veins, to my heart.
They choose this method to administer the chemo so that the harsh chemo drugs do not directly affect the more delicate peripheral veins, that may not be able to withstand the coming chemotherapy and would potentially get eroded.
It was a twenty minute procedure but the prep and consent forms ended up meaning the whole thing took about two hours. Honestly though it flew by, not a moment during those two hours did the friendly chatter and laughter stop for more than a few moments, when the nurses particularly needed to concentrate on something. I had beforehand spoken to my CNS about the procedure to put the PICC line in and some friends who already had PICC lines, which had helped ease any prior nerves, so when the day came round, thanks to their reassurances I was not too concerned about the procedure..
So what I’ll do in this post is just run you through what happened, so that hopefully if you are nervous about an impending PICC line insertion you will read this and feel a whole lot more chilled about the whole thing. Hopefully I’ll dispel any crazy myths about it, not that I’m sure if I was aware of any but you never know what old cancerous wives’ tales might be floating about in the wilderness freaking the hell out of some poor cancer patients.
So I went in and with the help of the kind nurse, went through all the consent forms, happy as Larry signing every dotted line in sight. She talked me through what they would be doing, and explained to me that the procedure would be done by a nurse led team. I wanted to include this point because I think it is important; so many people, including myself, aren’t really fully aware of what nurses actually do. Before all this I thought that the nurses’ duties fell solely on the ward, doing things like caring for patients and so on. The range and scale of the responsibilities of the nurses I have met through this is remarkable, and I have really realised how important and instrumental they are in the medical world. .
Anyway, then the other nurse joined us, I changed into a gown and together they scrubbed up and sterilised all the surfaces. This was the only point when I began to get a little bit nervous; they had warned me not to stress about how serious the sterilisation looked and their surgical scrubs, but this wasn’t what concerned me. Whenever I have something done, whether it is bloods, injections, or anything, I always have to look at the person doing it and watch like a hawk as they stick me. This time I couldn’t, due to the placing of a massive plastic sheet that blocked my view of everything.
The nerves only lasted a few moments though, as the confidence and teamwork of the two nurses inspired so much trust within me, I felt completely at ease with letting them do their thang. During the sterilisation of the room, they covered the leads of the ECG machine they would be monitoring me with throughout the procedure. As one of the nurses pulled the plastic tubing along the leads she remarked on the uncanny resemblance it bore to an elephant condom. As you have probably worked out, the nurses were absolutely brilliant and kept us laughing throughout the procedure.
They also told me something which was totally crazy, which is that if in bed I have palpitations it is just that the line has gone into the heart a little bit. JUST GONE INTO THE HEART A LITTLE BIT?!? That bit was a little on the freaky side but they reassured me it won’t kill me (I think everything will kill me these days). My best friend Kourosh did pose a good question regarding irregular heart beats around incredibly attractive persons though, asking me “What if your around me Coz I give you hear palpitations init.” I will be popping back into The Macmillan Centre asap to ask this.
They searched for a good vein on both arms using an ultrasound, and quickly found one on the right, which was the preferable arm anyway as being right handed and using that arm more means I am less vulnerable to blood clots around the PICC line. They administered local anaesthetic, warning me that that was the only part that would hurt, much like a bee sting. It didn’t hurt at all and as someone who has never been stung by a bee, I feel a little more confident that bees cannot actually kill me. We will see whether that makes a difference to my ridiculous bee-in-a-twenty-metre-radius flip out attack that comes happily hand in hand with each BBQ season.
So then they jabbed – that was the only bit I felt, it was kind of like an elastic band pinging but it lasted a split second – and fed the lead along my vein. They carefully measured the length of the lead and worked out the correct positioning using the electrical signals from the beating of my heart and the ECG monitor. It really was fascinating to watch, and I was so appreciative of the way in which they explained each step as they did it. Explanations are something that really put me at ease, probably because of my slightly control freakish nature, so the way they carried out the procedure was just perfect for me.
And finally it was all done, easy as that. They secured it using this fantastic thing called a “securicath”, which is like a little metal anchor that goes under the skin to hold the PICC line in place. Apparently this a fairly new invention, but one that seems to have solved the annoyingly common problem of PICC lines falling out when the dressings are changed. And since the dressings need to be changed once a week – well, you get the idea.
They covered the line with this antimicrobial dressing which has this yellowy looking, very attractive goo in it to fight infections at the point of entry, and on top of that I have this tubigrip bandage to cover the line, which my brother is going to be vey jealous about since he is completely obsessed with tubigrips. To the point where he wears them for every broken nail; one year, after watching him wear them nearly every day, I finally snapped and asked him when we were in the sea on holiday in America what on earth he was wearing them for this time. He wasn’t very happy due to the fact he wasn’t wearing any and it was just that it looked like he was because he was so pasty/white (actually that is misleading, his legs were white and the rest of him was a lovely red I think they refer to as lobster on the Dulux colour charts). Especially pasty compared to me, the golden beach babe Goddess of Banstead.
Anyway, I am going off on a tangent here and so I will rein it in. I’ve had bloods from the PICC a few times now and it’s just totally pain and stress free, I wouldn’t even be able to tell anything was happening if I didn’t look. They literally connect one of the lumen to a syringe and draw it out, then flush it with saline; the whole thing takes about thirsty seconds. The phlebotomists in the Macmillan Centre are probably the best I’ve ever met and always get my veins first time within about five seconds, but even they can’t beat this PICC line. The reason I actually got it so early, two weeks before chemo even starts, is because of the amount of bloods I need taken during this egg harvest and it really has been brilliant so far. Fingers crossed it will continue to be this brilliant and it will stay infection free and whatnot over the coming months, but if it does not I have every confidence that UCLH and the Macmillan Centre will sort it out.
I really am totally blown away by how fantastic it is here, by the building, the staff, the flexibility, the care, everything. I feel so lucky to be treated here, and I am so relieved that I opted to stay here for my care and travel into London for appointments, rather than transfer back much nearer to home where I was treated originally. UCLH and the Macmillan Centre have got it totally 100% spot on, their whole attitude to care is excellent and every time I have needed someone, whether it is for serious concerns or a minor question, someone has been there.
Even back when I had my ovarian transposition, my chemotherapy consultant, my radiotherapy consultant and a chemotherapy clinical nurse specialist (CNS) all came to my bedside for my appointment so that I didn’t have to move. (My most diva-ish luxurious hospital appointment ever). The care revolves around the patient in a way that I have only seen rivalled back at the Proton Centre, and we all know how much I love it there because I haven’t stopped bloody banging on about it.
And that right there is the whole piccture. (HA HA GET IT?!)