One of the commonalities of sickle cell warriors is that fact that after a zillion hospital admissions and ER visits, eventually, our veins go into hiding from all the trauma. The medications that help us also help to scare the beejesus out of our veins as well as all those blood draws! My hands are scarred up from IVs and I don’t even remember a time when I had good veins in my arms.
I’m down to my last good vein, and even that is getting hard and sclerosed. So in the near future if I keep getting sick, I’m going to have to put a longterm catheter in…yuck! These are the options for access that have been most frequently presented to me.
Porta-Cath: Also called a port, this is a closed access device that is placed under the skin usually on the chest wall. It’s an outpatient procedure done under general anesthesia, and once you get it, the port can be accessed periodically as needed with a big needle that fits right in there. When you go home, they take the needle out and you just have the port still in your chest covered by skin. It’s the most preferred for those on long term therapies, has the lowest risk of infection and is not detectable unless you are bare chested. It can be in you for months to years and will need period flushing with heparin (usually every month or so) to keep it from clotting up. I’m wary about having a lump on my gorgeous chest, but I guess you gotta do what you gotta do.
PICC Line: This is used for more short term IV management than the Port. It’s inserted in the hospital by a certified nurse done in a sterile environment through one of your arms and threaded to the superior vena cava close to your heart. It can be in for a maximum of 6-8 weeks. They usually don’t want to keep it longer because it has a risk of causing infection especially endocarditis. I’ve had 3 PICC lines all in the last 2 years and just have small scars that look like mosquito bites on my arms to show for it. Sometimes they leave it in after discharge for long term antibiotics or chemo.
Triple Lumen Catheter (TLC): This is in for the length of your hospital stay. It’s usually placed in the larger veins of the femoral or jugular. If it’s in your groin (Femoral) area, it has a high risk of infection, after all, your urinary & rectal tract are only a few inches away! Getting it in your neck is a real pain (I’ve had both). It may have 1-3 ports on it, which means you can get blood, some IV fluids and still get your pain shot through the other port. It has to be taken out at discharge though.
Those are the 3 main ones that I’ve come in contact with. My personal favorite is the PICC line, it’s right in the middle for efficiency, ease of use and it’s relatively fast to put in. A skilled nurse can do it in under an hour. So next time they mention any of these options, you are now in the know.