So, I have an infection on my right side.
I went in Thursday for my regular post-op follow up with a fever of 99.9, pain and thick, gross drainage on the right side. In retrospect, I wasn’t very clear last Monday that the thick drainage on my left side was coming down the tube, not just coagulating in the bulb. Thursday, the physician’s assistant was immediately alarmed and horrified by what was draining out my chest. That’s not a very good feeling, in case you’ve never had that kind of powerful reaction.
Somewhere between leaving for the hospital and the 45 minute drive there, my right side started turning pink. My doctor and I made the decision to treat aggressively (he said something about 3 weeks of antibiotics, yikes!) and I was sent running for radiology to get a PICC line put in. If you’re unfamiliar with a PICC (peripherally inserted central catheter), the doctor ultrasounds your arm to find a big vein and tubing is run from your bicep into your chest. I have a PICC that is 47cm in length, and it’s used to give myself IV antibiotics.
In retrospect, if I could’ve foreseen the issues I would have with this, I would’ve begged him to just admit me. But let’s get back to Thursday.
It only took 15 minutes to have the line put in and then I went back to my doctor’s clinic for my first dose of IV antibiotics, and then I was sent home after 3 hours there. Shortly after getting home, a specialty pharmacy delivered an IV pole, pump, and a very, very large box with the antibiotics, syringe saline flushes, caps, alcohol wipes, line kits, extension tubes — everything I’d need to set up shop. The next day (Friday) a nurse spent 3 hours showing me how to mix and set up bags of one antibiotics, how to inject one, how to clean up and keep everything sterile, how to start new lines, everything. The bag antibiotic I have to give myself every 6 hours, including middle of the night and early morning, so by the time my 6pm dose came around, I felt ready. And then there was air in the line, so the IV wouldn’t pump. I fought and fought and finally a nurse came and showed me how to clear the lines by tweaking and dumping out antibiotic.
Saturday, another nurse came for a regularly scheduled check in and watch my 12pm dose, which went fine. The other doses (6pm and 12am) went mostly well. I had a few issues with the pump registering air, but I was able to troubleshoot it myself.
Sunday, I was up at 5:30 to dose myself so I could get ready to walk a 5k. It was a perfectly crisp Fall New York day and 24 friends joined my team for a local Making Strides Against Breast Cancer walk. We had a beautiful morning trekking through an apple orchard, watching swans, stealing apples, and crossing the finish line. We made such good time that even though the walk was 40 miles from home, I was still set up and getting infused shortly after noon.
And here is where my troubles begin.
Zosyn is what I get through the bag, 100mL over 30 minutes. The nurse that I spent all of yesterday with can only guess that this bag was underfilled. With 5 minutes left to go on the pump, I get an error that there’s air in the line. I look up and the bag of Zosyn was very, very empty and so was the chamber at the top. I disconnected the IV from the PICC line and realized the PICC line was filled with blood. And I started to panic. There was some kind of disconnect with the operator and the visiting nurses because I didn’t get a call back from the on-call nurse for an hour and by then I was in full on meltdown mode.
Before the On-Call Nurse, my Saturday nurse had called to check and told me to flush the line, and by that point I couldn’t get anything to go through. Cue more panic.
The On-Call nurse came and struggled to flush saline through initially, but finally got it rolling. She left shortly before 3. At 4:45, she called to ask me to start my 6pm dose (I have an hour window on either side). I struggled to get the pre-antibiotic flush through, but finally did. The IV went fine and the post-antibiotic flush went fine. The nurse walked into my house 5 minutes later (roughly 5:30) and couldn’t get a flush through no matter how hard she tried. And this is where it started to get dicey. She phoned her boss and a couple of colleagues and finally called the On Call pharmacist. Both were concerned by how quickly this seemed to be happening, but the nurse’s manager said that young people heal quickly and that this isn’t uncommon.
The pharmacist and the nurse determined that it was either a) a placement issue, the PICC line was pressing against something that was prohibiting flow or b), and more likely, a blood clot in the line. The pharmacist had to go in and get the order for CathFlo from the plastic surgeon on call and the nurse left to get dinner while we waited. We got the CathFlo shortly before 9pm.
The CathFlo was pushed into the lines with a lot of force and sat in the tubing for about 45 minutes. Then, the syringes are pumped in a priming motion. The nurse was looking for blood return, of which there had been none when she was at my house at 5:30. Finally, finally after a lot of pumping, blood started to flow back into both syringes (there are 2 lines on the PICC). When she took them off, you could see the clots hanging off the end, super creepy. In the end, she didn’t leave my house until midnight, after she made sure that infusion was going well.
I held my breath when I got going this morning, but everything seems to be back to normal. “Normal,” because this a new normal and I don’t love it but it’s temporary. I won’t know what to do when I don’t have things dangling out of my body.