PICC-less and fancy free

Miss Z before going home from the hospital - nebuliser on face, PICC on left arm and cannula in right hand. Can't imagine why she doesn't like the hospital...

Miss Z before going home from the hospital – nebuliser on face, PICC on left arm and cannula in right hand. Can’t imagine why she doesn’t like the hospital…

For the past two weeks, Miss Z has had a PICC line. This is a type of central line that is inserted into her upper arm and runs in a major blood vessel to just outside her heart.

The purpose of the PICC was to give her two weeks of intravenous antibiotics without having to put multiple cannulae in the tiny, fragile veins in her hands, arms and feet. Miss Z’s respiratory and medical teams had decided that an intensive course of antibiotics was the best way to kill off as many of the nasty bacteria that have made her lungs their home.

I was a bit nervous about the line being inserted – since it is done under general anaesthetic (GA), which can be an issue for kids with respiratory problems, not to mention Miss Z was in the process of recovering from influenza, during which she’d spent several days on oxygen.

In the end, however, it was a non-issue. They decided to ‘twilight’ her rather than use a full GA and the procedure took approximately the same amount of time it took me to walk from the operating theatre to Subway, buy a sandwich and return to Miss Z’s hospital room to eat it.

And so we began the 2-week course of antibiotics. I had insisted that the course was done from home (we both would have gone mad, stuck in the hospital for two full weeks) and so we were sleeping in our own beds the night after the procedure. Miss Z’s PICC line, antibiotics and chest physiotherapy were managed by the fabulous Hospital in the Home (HITH) service, that sent a nurse and a physio to us every day. The nurse checked the line, did daily obs (temperature, heart rate, respiratory rate) and gave Miss Z her antibiotics. The physio did chest physio twice a day (basically pounding on her chest to loosen up the goo, encouraging her to cough and then sucking it out of her nose and mouth as well as monitoring her SATs (blood oxygen levels) and tracking if the antibiotics were improving her chest.

I have a huge amount of gratitude to the nurses and physios who have visited us over the past two weeks. Every single one of them was friendly, supportive, professional and kind to Miss Z. And they all reminded me that I had a 24-hour number to call if I had any concerns at all.

Care in the home made such a difference to Miss Z. To say she hates the hospital is an understatatement. And you can’t blame her – she associates it with unpleasant experiences for a very good reason. I don’t think I’ve yet recovered from the time it took three nurses and me to hold her down while an Emergency doctor tried repeatedly to get a cannula in her as she screamed at the top of her lungs. Or how they used to have to wrap her in a sheet and hold her down in order to get her naso-gastric tube reinserted after she had pulled it out. If I haven’t recovered from those incidents, how do you think she feels when she finds herself back in the hospital?

In comparison, Miss Z was all smiles for the HITH nurses. She was often so busy wiggling and singing and chatting that the nurses struggled to take all her readings. The PICC line worked beautifully and didn’t cause her any discomfort – in fact, when it wasn’t in use and was wrapped up against her arm, I don’t even think she noticed it.

The physios had a harder time of it. Miss Z loves the percussions and vibrations part, but is not a fan of suction (can’t really blame her) and being forced to cough up big globs of phlegm isn’t her idea of a good time. That said, I think she secretly found one physio hilarious (particularly her routine about nose picking, which she deployed right before sucking the snot out of Z’s nose), but wasn’t going to give her the satisfaction of a smile…

Our 14 days of antibiotics finished on Wednesday. And I’m hopeful that they have given Miss Z a boost. She isn’t coughing as much and is a much happier little girl than she has been in recent weeks (then again, she did have the flu…). Today we visited the Respiratory doctor, who was happy with her progress. And then the nurse arrived and pulled out the PICC. And I really do mean, pulled it out – nothing more sophisticated than that! I’ve seen a lot of medical procedures, but this one made me ever so slightly queasy – probably because the line was really long, so she kept pulling, and pulling. I think it bothered me more than Miss Z, who only got irritated when the nurse applied pressure to the hole in her arm (because it was an actual hole) for a minute  afterwards to stop the bleeding.

So, Miss Z is now PICC-less and the waiting begins. Z’s doctors hope that this will keep her good (as in clear of chest infections) through the summer. After nearly a year of constant chest infections, I’m almost scared to hope for that much… but wouldn’t it be lovely for her to have a break from the coughing, the sleepless nights, the vomiting, and the constant visits to the hospital.

The plan is to wait and see how she goes. I’m keeping my fingers crossed.

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