The Cough - The Picc Line Story

Once upon a time there was The Cough. It was a nasty cough, this one, and it bothered its owner enough to actually ask his doctor about it. It got worse. Much worse. And over the next two years became the controlling factor in his life.

The owner was/is me. The full story of The Cough would take many blog articles. After all, the entire saga played out over two years. It was quite a medical drama. It shouldn't have been but it was.

The story of its origins will have to wait for another day, this one is about Picc Lines.

A Picc Line is long, slender catheter that gets inserted into a vein and pushed up through said vein until it is within a few inches of the heart and is used for the delivery of antibiotics over an extended period of time. Because The Cough was caused (or made worse) by a bacterial infection and the offending bacteria was situated deep in the lungs (and may have been somewhat resistant to many routine antibiotics), the Picc Line was the delivery method of choice.

In the course of the two years of The Cough, I had two Picc Lines inserted. Within a year.

This is the story of the second.

I had been getting along quite well actually. I was using two inhalers (albuterol and Flo-Vent) to keep my airways open along with excessive doses of Ciprofloxacin (antibiotic) and small doses of prednisone (a steroid and all around wonder drug). I had just returned from a visit to San Diego and Las Vegas and was feeling fine. My infectious diseases specialist decided I should try a different antibiotic, one that allegedly was supposed to be designed for our suspect bacterium.

So I did. Three days later, I was headed for the emergency room with severe breathing problems. My O2 saturation level was 61% which is not very good. It took them some time and three nebulizer treatments to bring it up to where they felt comfortable putting me in a room where I would spend the next 6 nights.

The next day I was scheduled to have a Picc Line inserted. This time by a surgeon, guided by a fluoroscope.

I was wheeled down to the radiological rooms where I met the illustrious surgeon. I was stretched out on a table, machines put into place, left forearm swabbed with antiseptic, and told how simple the procedure was.

I had already had one inserted less than a year before. That time by a nurse who merely made a small incision, inserted the catheter and ran it the distance her previous rough measurement indicated. I was then wheeled down to the X-ray folks who confirmed she had done a great job.

This time, the surgeon chose to do it a little differently. After the small incision, he inserted a guiding catheter, which has a larger diameter than the actual Picc Line catheter, into which he intended to insert the actual catheter I would be using. All guided by watching the fine gray scale picture of the inside of my arm and left chest area shown on the fluoroscope. A safer procedure, he said.

So, naturally things went wrong.

The guide sheath failed to insert properly and then had to be removed. It had slipped further in than it should have. That is, the near end had moved into the vein rather than staying at the opening. This was one of those "oops!" moments you do not want to have happen when a procedure is being performed.

In the process of retrieving this sheath, the sensation of having my arm turned inside out was felt. The small incision got a bit larger. And my anxiety sharpened.

After the alleged surgeon finished torturing me, he informed me that "we'll have to insert it in the other arm."

To which I replied, "Not now and not by you."

Three hours later, the Picc Line was neatly and painlessly inserted in the right arm by a nurse in less than 3 minutes from the time I entered her room.

While waiting for X-ray to confirm the nurse did the job properly (she had), the alleged surgeon happened by, saw me, and profusely apologized for the problems and discomfort he caused me. Whereupon I informed him of the quick, painless, and excellent job the mere nurse had done not long before.

He walked away in a huff.

I still have the scar on the inner elbow area of my left arm. Necessitating that all future intravenous procedures be done on my right.

Thanks a lot, Doc.