Re: PICC line from hell—questions about maintaining

From: Marlene

Date: 8/31/2004

Time: 10:04:42 AM

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Hi Becca,

John had a Hickman in his chest and it sounds like they have the same type of caps (claves) you have. The line itself did not have a valve. But there were clamps on the line to prevent anything from coming out when we changed the caps. And it does make you worry to see those exposed caps because you wonder how easily they can be breached. If it’s any comfort to you at all, John’s Hickman was in for 14 months and he never got an infection in the line or a blood infection. We found that every hospital and dr’s office follows different protocols when it came to changing the caps. When we were up at Hopkins, the caps were changed weekly. During this time, they were accessing his hickman daily with blood draws, transfusion and administering drug. When we got back home, the nurse at the doctors office would change the caps everytime she took blood. If there were no blood draws, then we would change the caps weekly. When he went to the hospital for transfusions, they never changed the caps after a transfusion. So you can see it’s all over the map. I just made sure that when I flushed the lines, I really scrubbed the ends with the alcohol swabs and at a minimum, changed the caps weekly.

John’ also had problems with the skin around the entry site and with the entry point of the line. I would continually change the size of the bandages. We had to stop using the Tagaderms for quite a while and resorted to mutiple layers of guaze and different tapes. We had to make sure to anchor the line really well so that it wouldn’t pull on the skin. We did use Skin Prep for quite a long time. It’s supposed to protect the skin. We also used adhesive remover to get the tape off. Your home healthcare should be able to give some guidance on the different skin barriers that are out there which may be helpful. But manytimes they are clueless. We were told that the Chloraprep we were using to clean the skin was very harsh on the skin. We got to the point where plain old soap and water had to be used along with saline solution because we had to change the dressing daily.

I hope this helps and we wish you the best with this second treatment. I really hope it kicks in for you.