|Ports, PICCs and IV’s
Allison’s had them all. Each type of intravenous access has its own set of pros and cons. I cannot reiterate enough that this is my experience and my experience only. It should not serve as being representative of how each are addressed everywhere, but might give you an idea of how we have handled them.
IV’s ~ the simplest and most basic route of access (unless, of course, you have no veins left to poke and then it becomes a little trickier). Used to deliver saline and other meds, IV’s are generally given on the back of the hand, wrist, or even forearm. We’ve even had them in her feet and on her head (yes, her head). This is what many people are used to in a hospital setting. They are generally used in the short term, with most “going bad” within a few days. The general rule of thumb around our hospital is that if you have an IV and it’s working, we’re keeping it, whether you need it or not.
A PICC line is a longer term “IV”, usually placed under sedation that snakes a catheter through your vein to the area of your heart. Used to deliver various types of medication, PICC lines are generally given in the arm or the leg. Allison, of course, had a PICC line in the side of her head for a few months in the NICU. In our NICU, we did not change the dressing on Allison’s PICC line during the entire time that she had it. They were going through an experiment to decrease the infection rate of PICC lines and the only people allowed to address PICC line dressings were the Nurse Practitioners. Allison never got an infection in her line, but we finally had to remove it because the connection finally broke from all of the use that it got! PICC lines are generally placed in CF patients (who do not have a port) for delivering IV medication (antibiotics) during a “tune-up”; many go home with their PICCs and finish out their course of medications at home.
(A broviac is a central line placed directly on the chest for long-term access, and works similarly to a PICC line. You can draw labs off a broviac; sometimes you cannot do that from a PICC line. I believe that the dressing needs to be changed daily.)
A port is a surgically placed central access point. It is left under the skin and is accessed through the skin using a special needle (i.e. Huber needle). Many CF patients choose to have port placed to save them from repeated IV’s and PICC lines. Allison had a port placed in July of 2005 and had it removed in December due to an infection that we could not get rid of. (We had been using it for TPN, which we discovered later was contraindicated for such use, as TPN is a very sticky substance that can cause bacteria to stick in the port reservoir.) Allison’s port was in her upper right chest area, although they can be placed lower down on the ribcage and even on the arm in some cases. Ports do not need to be accessed at all times, meaning that showering, swimming, etc. should not be a problem. When not in use, the port needs to be flushed with saline and heparin about once every 3-4 weeks to keep it patent. However, when you are receiving medications through your port, you will remain accessed for that duration of time and the site will be covered with a dressing. Needles and dressings should be changed at least once a week (we had home health care that came to help with that ~ many families choose to do it themselves to save them from exposure to outside germs). Here’s a few pictures of Allison’s port when it was inserted (and accessed) and then when it was removed:
Again, please remember, this is our personal experience with these things; this shall not be construed as medical advice of any kind. Please consult your physician before making any changes to your health care plan.
Be a hero. Designate yourself as an organ donor.