The first four weeks spent at the hospital are already becoming a bit of a blur – it's now five months ago.
On arrival we were settled in with tea and toast on the Borchhardt Ward. The next days were filled with consultations, tests, briefings and the first treatments. More needles at first. Kezia's veins were by this time getting very difficult to find. Sometime during the first week she had a minor operation under general anaesthetic with three objectives:
Take a bone marrow sample to confirm what they had seen in the blood.
Take a sample of spinal fluid – to see if the leukaemia had spread to the central nervous system and thus potentially the brain.
Install a Hickman Line.
I'll discuss the treatment/medicine in a later post. But the latter, we'll deal with here. The Hickman Line is basically a tube that runs from a large vein feeding into the heart (the Superior Vena Cava going into the heat's right aorta for the technically-minded) and comes out at the top left or right of the chest. Its function is to allow medication to be administered and blood samples taken without the need to access veins with needles. You bet Kezia and ourselves were relieved!
In the initial stages after its installation much care has to be taken that the Hickman Line does not move internally. Each time medication is given through the tube, a little blood is drawn off to ensure the tube has not moved. This did in fact happen to Kezia and a couple of weeks later she had to return to the operating theatre to have it reinstalled.
Externally, a loop is put in the tube and the loop is taped to the chest. This is so if the child pulls on the tube, she pulls out the loop rather than pulling the tube out of the vein.
When not in use, the tube is capped or clipped to ensure that dirt or other foreign matter that might cause an infection does not get into the tube or body. In fact, tube cleanliness is of utmost importance and the tube is flushed with saline after each administration of medication or blood sample. When the child becomes an out-patient, parents are shown how to clean the tube. This is done on a regular basis whether or not medication is given or blood samples taken. Parents are also given a temporary clip in case the main clip breaks or fails. This must be carried everywhere the child goes.
Later in the treatment when medication is less intensive a Portacath will replace the Hickman Line. This is basically a silicon bubble (the septum) installed under the skin with a tube going to the same vein entering the heart. Medication is administered and blood samples are taken by means of a needle/syringe to the silicon bubble. Just a small pin prick to the skin. Advantages are a) the child cannot pull it out b) it's easier to keep clean.