Saturday I got a PICC line. Woohoo! Today was the first day of the 4th round of chemo and it was *much* more enjoyable because of this. Instead of poking me in the arm looking for a vein each time, all they had to do was plug me into the IV drip and that was it. Also, the PICC sticks out of your upper arm which makes it a lot easier to move around while the drugs are going in (which can take a few hours), compared with having a normal IV poking out of the back of your hand or forearm. That was a pain and made it annoying to do things like eat or read a book.
A PICC, or peripherally inserted central catheter, is basically an IV tube that is poked into your arm and threaded up a central vein all the way to your heart, into the SVC (superior vena cava). I had a single-line PICC put in, but they make them in multiple-line versions as well. It's been in 2 days and I hardly notice it's there, but I'm having a lot of fun showing it off to people. I feel like Iron Man. It's actually called a PowerPICC and the tubing is purple. The web site hypes it hard, with fancy graphics and sound effects. I think I even saw a slogan like "get the power of purple" somewhere in there. Wow.
Anyway, the procedure wasn't that much more complicated than running a normal IV line into your arm, except they spend a *lot* more time making sure everything is super sterile. More than half of the procedure was spent sterilizing everything, not because the tube goes near your heart, but because it's in your body for so long. The risk of infection is a big deal. I was covered from head to toe with paper except for a little cutout where the tube went in my arm, and the nurses not only had masks but plastic face shields as well. Crazy. But done properly and the same PICC line can be left in for up to a year.
They used a couple of cool technologies to actually insert the line. The first was a simple ultrasound (complete with goopy stuff on the end) to figure out which vein to go into, since on your upper arm your veins aren't visible at the surface. On the screen I could see a cross-section of my arm and the vein clearly showed up as a big black hole. It was kinda cool. She smashed it around a bit with the ultrasound tool and you could see it pop back up each time on the screen. I asked if it was a boy or girl (haha). Then, using the ultrasound, they poked in a needle and inserted the catheter (containing the guide wire) into the vein. Once all that was in I watched a little apprehensively as she pushed (and kept pushing) this *long* purple tube into my arm. I couldn't feel anything, though the IV nurse said to let her know if I feel anything funny in my neck, since they catheter can sometimes make a wrong turn and go up into your head. Eww!
The other cool device they used was a large magnetic sensor that sits on your chest and can detect where the guide wire and catheter are in your chest. So a few seconds after she was threading it along, the guide wire popped up on the screen and she could see exactly how close to the heart it was and what depth it was underneath the skin. When it was all done, she pulled out the guide wire from inside the catheter and taped everything up. Then it was off for a chest X-ray to make sure everything was in the right place. I have a little sock to wear over it so that the end of the tube doesn't dangle around and get caught up on something.
Finally, they taught Johanna how to flush the line with saline and heparin (an anti-clotting agent) to keep the line clean so that it doesn't clot up. They let her practice on me and she did great :) If the PICC stays this comfortable, I may just leave it in since it can be used for transfusions and blood draws as well, until I get the Hickman port in a month, which is what they'll put in just before the transplant. A Hickman is similar to a PICC except that it sits right above your heart and seems to be used for more heavy-duty stuff.