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Bad, bad patient and leaking P.I.C.C Line

Posted Nov 19 2009 10:08pm
I had a great two days at work last week, awesome stuff however as much as I would love to share what I am doing and class antics I don't want to identify my job placement due to the smallness of my country and student confidentiality.This is mainly a medical based blog also. Thank you to Dr D for writing a wee blurb about mwah, Blush blush the picture accompanying it is quite hideous. He writes a blog which includes patient input and imparts impressive wisdom from the medical perspective. Check him out!

My P.I.C.C line is being an arse though. Aside from some intermittent neck pain last weekend which worsened when lying down, it has been infection and trouble free. I have done my best to ensure it stays infection free as Im so sick of blimmin antibioics and the fungal infections which plague ye.

Anyway last Monday I noticed some air in the distal section of the line. Me thought o.k maybe this normal. However the next day after showing and discovering my inside dressing was damp in spite of plastic bag coverage that the air had increased in the line.
I couldn't understand why the dressing was wet on the inside as it was still sealed. Called the district Nurse to check out the dressing.
She was brilliant and explained how the ward had dressed my line incorrectly, the strips covering the line were exiting out of the dressing wicking water in. The air in the line was another thing. Air was in the extension line at about 50%  and 50% saline flush. So the nurse changed he whole extension line and positive pressure hub and I was to watch it to see if air returns..

Two days later I woke in the night and had excruciating pain in my upper back between my shoulder blades. I didn't know what it was but I was desperate for sleep as I had to work the next day, the pain was bad enough for morphine so I took some and returned back to sleep.

Later that day again after showering and removing my arm cover I noticed air had returned into the line. Damn, phoned nurse, nurse, had to wait awhile and as I was due to take my daughter to the airport later on, I phoned the ex hubby for advice as he has done P.I.C.C lines in the past.
Ex hubby exclaimed it could be air embolism and that I should go to Emergency Room. He then called me back later to say he spoke with a vascular colleague who said yeah go up to E.D. Damn damn damn this was really annoying me. I felt fine aside from my usual abdominal issues. The nurse phoned me back and said yes the Emergency Room.

Long story short, wasted precious time up in E.D, people were clueless as the special Department which deals in P.I.C.C lines had closed until Monday. Two things went through my mind, please don't pull this line out and hurry up as I need to go to the Airport!

They did a chest xray to see positioning, then after grilling me on how I was flushing it. Stop Press.
Firstly I don't touch the thing, it only had flushing once a week by the District Nurse, it currently doesn't have I.V A.Bs going through it as I'm chocker full of Oral A.Bs. Finally I aint touching that thing with its Positive Pressure valve as I don't want air rushing through it giving one a Cardiac Arrest (as said by ex hubby if it continued filling up with air).

The Dr in E.D decided to clamp it off "No" one shrieked shrilly. I had been told several times this special Positive Pressure Valve is NOT to be clamped under any circumstances. They looked at one weirdly, I looked back at them weirdly, I needed to beat the feet outta there, a plane to catch.

I don't know how friggin air was getting in the line as long as it stayed peripheral and away from my chest cavity, I was all good. They sucked the air and some blood out, changed the valve to a Hospital hub which required 24 hour Heparin flushes, it was well clamped, I was to return to them every 24 hours until Monday. Damn, gah.

Last night I returned as summoned by the Gods of E.D. Just to wait over 2 hours in a freezing waiting room, that was rapidly filling up with emergent cases. My ovary was ovulating (it has a tendency toward haemorrhagic cysts) on the right hand side and the Neobladder was crushing it periodically, causing radiating vaginal and leg, back, abdo pain. I got it under control by about 2a.m.

 Sitting for two hours on what would feel like a testicular kick to a guy, on hard chairs I had enough.
A five minute procedure, that's all it needed, I became a bad patient and left. Pain, tiredness, freezing cold waiting room, a lovely apologetic nurse, however I felt it was a waste of time.

More and more patients flooded the area, I knew I would be there for hours, zoom, I was speedy gonzales. Yes I have probably  now been labelled a non compliant patient. I am a bad bad patient.

I called the District Nurse begging them to come flush the line, a no go as the Hospital didn't fax them an order for the Heparin. Gahhhhh now I have to go back up there soon *grinding teeth* I know as soon as I reach the Triage window and they pull my notes I'm going to end up with a massive neon light above my head screetching BAD PATIENT.
I'm not dead, its all good and they weren't too concerned about my departure, as they didn't call me at home demanding why I had left.
Sucks to be me, so now I have to leave to visit E.D. Breathe breathe. Has anyone ever come across Air in P.I.C.C lines while it has a Positive Pressure Valve attached and not being used? It is a brand new type of Valve being used here, don't know name of it.

UpDate
Been there had it flushed again and hep. locked. I was wrong, I didn't get the Non Compliant Patient level of care. They were fab and totally understood why I would walk outta there last night, they understood the inconvenience and frustration. .My recordings were up a bit tachy and a higher than usual B.P I'm not sure these antibiotics are working. This morning my temp was up but I didn't tell them that because it was good when they took it this arvo, I have completed the course as of today and don't want any further problems....
Tomorrow my Surgeon is doing uro dynamics again this time positional, not the usual stand all through it procedure which is a waste of time for a Urinary Diversion patient. But back to E.D for my P.I.C.C line maintenance first.
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