Wake Up ICU

2012 was another year packed with medical issues. I have mentioned the Hickman IV line I had in my chest, but I have not talked about the problems they can cause. In 2003, the day after I was admitted into UNC, I had a Hickman placed. It is a central line inserted into the chest, goes under the skin, around the clavicle, and into a large vein that goes to the heart. It differs from a port because the Hickman is always hanging out of the chest. A port is a box under the skin that a large needle is placed into with the IV line attached. The needle can be removed and replaced as needed. The particular Hickman I had was one large catheter coming out of my chest that divided into three different lines so that multiple medications could be given at once. I remember at times having multiple IV pumps on one pole beside me with several different medications on each pump, and an IV line going to all three lines of my Hickman.

 It was aggravating having the central line, but it was a life saver. I had all my lab work drawn from the line and I was given all of my meds through it. I never had to get stuck for blood or an IV except on certain occasions. Special care had to be taken to prevent infection. Keeping it clean was very important. Three days a week the dressing had to be changed, and the lines had to be flushed to prevent clotting. In the hospital, the nurses took care of it, but at home my mom and I had to do it. The Hickman could not get wet, especially in a pool or the ocean. I did get it wet in my shower, but I did not soak it and momma changed the dressing as soon as I got out.

 I learned a really big lesson once after going to Myrtle Beach. I was sitting next to the water. I did not think I was getting my chest wet, but a couple of days later I began running a fever. After BMT any fever over 101 was reason to go to the hospital. My mom and I packed our bags and headed to UNC. The first thing the nurses do is draw blood cultures from your line and from your arm. After 2-3 days the results from the blood cultures should be complete. Hopefully, if bacteria grow, they can identify what it is and the best antibiotic for treatment. Well, this particular time an odd bacteria grew. It was determined the bacteria came from the ocean and usually only dogs had. My family picked on me and said they should have taken me to the veterinarian. WOOF! WOOF!

 Bacteria can enter the body through the central line and cause quite an infection in the blood. When this would happen, my line would need to be removed, and IV antibiotics had to be given. When the bacteria   cleared and the doctors felt it was safe, a new line could be placed. Bacteria can stick to the plastic of a central line even after antibiotics are given. The infection is in your blood and can be deadly if not treated promptly and correctly. I have had so many lines placed in my chest I have lost count. Each time they would switch sides to the left or right chest. Having a Hickman removed is not a surgical procedure. I remember three things during this entire process that were the most painful and most horrible experiences ever. One I have mentioned before was the second fibular graft hip surgery I had when the doctors had to turn off all pain meds and my epidural after my blood pressure dropped to a dangerous level during surgery. I woke up in so much pain and it was several hours later before they were able to administer any medications into my epidural again.

 The first memorable extremely painful thing I remember is when I had my first Hickman removed. The doctor came into my hospital room for what he thought would be a simple procedure. I had never had this done so I was nervous. The doctor was a resident and evidently had not performed this procedure many times. He did not give me any premeds because this was going to be a “quick, simple” procedure. He approached my bedside, positioned me like he wanted, and explained what was going to take place. When doctors place the Hickman, stitches are placed around the catheter where the line enters the chest to secure. After time the stitches grow out and your skin attaches to the line at that point. Under the skin, several inches above the insertion point, there is a cuff. The small cuff is around the line, and the tissue under the chest attaches to help hold the line securely in place. Well, this doctor sets up his tools on the bedside table and starts injecting the Lidocaine to numb the area. He takes his scissors and starts cutting the skin loose from around the line at the insertion point of my chest. The doctor gives it a gentle tug and nothing happens. He takes the scissors and cuts a little more followed by another gentle tug. An hour later he is sweating, mom is pacing back and forth, and I am trying not to squirm, gripping the sheets, and clenching my toes. At this point, he is shoving the scissors under my skin and up my chest several inches, parallel to the line, trying to cut the cuff loose where the tissue had attached. Finally, he separated it and pulled the Hickman out. Mom followed him out of the room. He told her that was the hardest line he had ever tried to remove. For me it was torture. Later an experienced doctor told me that if you press and massage the chest wall over the cuff, the cuff will detach from the line. Then the Hickman can be pulled easily through the cuff. The cuff stays but it causes no harm.

 That incident was in 2003. After several noneventful line replacements, the one in 2012 was too eventful.   I had another bacterial infection in my Hickman and it was removed. I went into the operating room about a week later to have a new one placed. I had had this procedure many times so I was familiar and not worried at all. The anesthesiologist gives you a little sedation and pain meds during the surgery, usually, I was asleep the entire time. This particular time, thankfully, I woke up. I woke up and I couldn’t breathe. I told the doctor and the next thing I new I was waking up in ICU. After nine years of lots of hospital stays and almost death, this was my first ICU admission. One of the risks of having this procedure was an itsy-bitsy chance of a pneumothorax. Well, of course, that happened to me. The doctor had punctured my lung and it collapsed. Needless to say, he was unable to place the new Hickman. For several weeks I had to sleep sitting up and it hurt to breathe for a long period of time. After I had recovered from the collapsed lung, I went back into the operating room for a new Hickman. I was a little uneasy going in that time, but I knew I could not worry about what could happen.

 You can’t go through life worrying about what could happen or what has happened. Doing so will leave no room for the happiness in between.  Worry will take over your joy, not to mention, you will also make everyone around you miserable. Do what you can to make sure things go smoothly. The next time I had surgery to place a new Hickman, I made sure the doctor was aware of what had happened in the past. Be an advocate for yourself. You are not stepping on anyone’s toes or hurting their feelings by standing up for yourself. When you make it over the bumps in the road it only makes you stronger. Say a prayer and give it to God.