Hickman Line Update - the good the bad and the ugly

Hickman fitted at Chester with Stoma Ring

I thought I would give you an update as to what happened with my Hickman Lines.

Prior to coming into the Royal I had a new line fitted in Chester, the reason being that last one I had for nearly 7 months I got an infection in, Which was a shame as it worked really well and I never had any problems with it, that was also fitted at Chester.

When I cam around after Chester fitted the line on the Wednesday prior to coming in I was surprised to see the way they had secured it. They used what is called a stoma ring, which is normally used for colostomy bag, stuck it to my chest and then secured the line to it with several sutures (stitches).

Chester did test it to make sure it was working, but struggled to get blood out. It certainly wasn't flowing as well as my last one.

The Stoma ring definitely secured it well, but it was difficult to clean the area around the line due to the plastic of the stoma in the center of the ring. They had cut a whole in it so that the line could be fed through, but it certainly wasn't enough to gain access for cleaning all the way around it.

When I arrived at Liverpool and they first looked at my line to make sure it was OK they were really surprised at what they had done as they had never seen anything like it before. The nurse redressed it, but couldn't clean it for the reasons above and she was concerned about infection if she couldn't gain access properly. She but another dressing over the top and referred it to another person to evaluate what to do. In the mean time they were using the line to insert fluids etc and even the chemo.  They did manage to get some blood out of it on the first day, but like Chester it was difficult.

When they came to take blood the following day, they couldn't get anything at all, no matter how hard they tried. Using all the usual methods of breathing and moving and arms waving etc. I've blogged about it before, but will cover it again here. I was referred to the Line Specialist who was again shocked at the way it was done, she did agree though that the line was very secure and for that purpose it worked well, but not for someone who was about to undergo a stem cell transplant and required access to the entry point of the chest for cleaning. It was so unusual for them to see the stoma set up that they called the hospital photographer to come over and take some pictures for them so they could use them in training purposes. I had to sign a document to say that they could use, which I didn't mind doing as I will always help where I can. Helen the line specialist removed the stoma ring and cleaned it up so that the nurses upstairs could gain access and clean it when necessary as well as make sure the line was still secure. To do this use used several steri-strips in a circular cross over fashion. The line was wrapped in a circle still in a similar way that Chester had done it. Sorry I don't have a picture of this, but if you can image the picture above, but without the all the plastic etc and then stuck down with steri-strips going all the way around it in X type fixing, you will be somewhere there!

As for the line not working, Helen had tried vigorously to get some blood out, but couldn't. Believe me she tried every way she could. When I left I was quite sore as she gave it a proper scrub and a clean. I was told that there were a couple of things that they could do. There was a fluid they put in the line and leave for a couple of hours to remove any blockage, that's if it was blocked or it was possible that the line was touching the side of the wall, so every time they tried to yield any blood it just sucked the side of the wall in an blocked it. To find out though they would have to take an X-Ray.

Once I had the X-Ray and the results came back, I think it surprised them all. The line was far too short. it was only just inside the vein where it needed to be. So much so that they were worried about even putting anything through it, it could have easily not gone into the correct place and maybe even put the Chemo into my lungs (that's what I was told, I'm not sure how accurate that was though, so don't quote me in any medical journals). It hadn't fortunately done any damage whilst using it, but it certainly need to be looked at. what they proposed was that they use the current line as a guide and slide down a new line, but longer into its place.

The perfect Hickman line fitted at The Royal Liverpool 

They couldn't get me down to the operating theatre on that day, so I had to have it done on the same day as my radio therapy and stem cell transplant, but that's another (blogged) story. When I was in theatre with the surgeon I explained the reasoning behind what they were doing and after a thorough look, they decided it was less painful for me to have a new line. The line that was in from Chester was in a vein that slightly damaged so they probably wouldn't be able to get a new one inserted into the same place without it causing me quite a bit of pain and would be a difficult procedure to perform. By far the easiest both for them and for me would another new line. I agreed to let them do it, but asked for some sedative as I know how uncomfortable they are whilst being awake. They used the old line to get some sedative into me, so it couldn't have been that badly placed for inserting anything otherwise they wouldn't have used it, would they?

I had the usual couple of days with a bit of blood from the surrounding area of where the line went into my chest, but I have to say it was looking pretty perfect they way they had done it. I think the surgeons were on a bit of mission to do better than Chester had. Not only does it look good, but it works just as well as the one I had done in Chester that lasted several months. So I now have a good looking line that they can use for both inserting any fluids and yielding any bloods that need to be taken.

Hopefully this will be the last line I have for a while as I think four is enough. My chest looks like I have been shot, with lots of scars and holes.

I was told that my situation will probably change there procedure at the Royal and they will start to X-Ray patients prior to using the line, just to confirm they are safe to use, rather than assume they are OK.