PICC Line Pity Party

Well the PICC is in and to be honest of the process of actually getting it put in -- I have had worse
IVs.

As for how I feel today ... well, I know that this will get better because I will continue to heal and get less sore, and I will learn how to navigate all the stuff that is so foreign and new right now in no time.  So I know this will get better.  But for now I just want to feel very very sorry for myself.

I hurt.

I feel so unable to do anything.

I am panicking about my lack of ability to do anything independently.

HG has made me such a shell of my usual me.  The energy I had, the things I did, have all changed.  Now, typing this is hard and I have to do it in stages.

I run two Etsy shops.  Well, I did.  I do home preschool with the Beans.  Well, I did.  I manage the house, cleaning, cooking, and schedules of my family.  Well, I did.  I feel like I contribute very little outside of growing this little person, which I know is a monumental task and everything ... but it breaks my heart to see how tired my husband is.  How my kids are gradually getting used to what I cannot do for them.

Now this ... I had a hellova time getting myself dressed today.  I am not even hooked up to fluids because the nurse wasn't able to come out yesterday.  That is two more lines connecting me to something that presently I don't have to deal with.  And I still barely got my socks and shoes on.  I needed to flush the PICC last night and Bunyan had to help because I cannot hook the syringes up independently given where it is located.  At least not yet, I thought I couldn't with some of my IVs and I figured that out.  I know I will figure out whatever I can, I know that I will have help with whatever I can't.  I just don't want to need to.

Fifteen weeks.  There are fifteen weeks left in this pregnancy and I may be on the PICC for every last one of them.  That, on one hand, feels depressing and on the other is a lot of time to figure out a new normal.

I just don't want a new normal.  I want to be just plain old normal again.

But I won't be.

Honestly I will never be quite who I was before this again.  This is the kind of life experience that changes you a bit.  I value my health more now than I ever could have had I just always had it to take for granted.

My nurse comes in a few hours to actually hook me up to the fluids and teach me how to use this sucker properly.  I will get all my questions answered and she will be here once a week to help me troubleshoot and change the dressings.  I know it will get better.  Sometimes you just need to give yourself a moment though, and now I kinda need one.  I need to acknowledge that this is hard, this sucks, and this is overwhelming ... but it could be worse AND it will be worth it once the baby is here.  Once my nurse gets here it is about coping and functioning again, I will have some independence even if it isn't the amount I want.  I need to make a list of questions and stuff.

But for now, I am taking that moment, because I have a lot of work to do later.

HG & IVs Post 3: Random, but good to know!

This is the first post in the HG & IVs series.  If you found this on accident, super!  Follow the links to move to the next post in the series, or head back to the intro post if you want to know what to expect in this set of posts.  If you are looking for the HG Treatment Series about subcutaneous Zofran or Reglan pumps go here for the intro post to that.  

The IV series feels like a lot less than the pump series was, so I keep wondering what massive part I forgot.  In truth, IV treatment doesn't have quite as many unknown parts to it that I think the pumps did, at least for me.  Here though we will briefly talk about some of the random stuff that popped up while I was on IV treatment at some point.  Please keep in mind, if you are here because you googled something to troubleshoot your own IV that I am in no way an authority on this and you should speak with an actual medical professional on it.

So, like I said this is random and I will update it a bit if I think of something else, but here we go.  Tips, tricks, problems, and whatever else I can think of!

The fluid bags themselves:  I never discussed what was in my IV bags because this is highly individual.  For the most part, I gather that people get one or a combination of the following:

1. Saline -- salt and water
2. Lactated Ringers -- salt water and sugar
3. Banana bag -- the above plus minerals (it actually is bright yellow)
4. TPN -- Total Parenteral Nutrition, which will be specific to you

What you get is dependent on what you need and what your doctor orders.  It may change too.  Some people also may get other supplements (like iron for example, but I have heard that stings going in) or medications via IV.

Pillows:  My husband jokes he will need his own bed soon because I am a bit of a pillow collector.  The IVs made this worse, because I find that if I make a little throne for my arm I am much less likely to bump or injure my IV in my sleep.  I also seem to just keep it in a better spot this way so it flows better when I am having a rough IV that wants to clot off or die.  I use the hot pink pillow you may have spotted in some of my pictures, it is a small one that can rest in my lap, on the arm of my recliner, or on my tummy/side when I am all propped up in bed on my other pillows.  As my tummy grows this may need adjusting, but for now that soft pillow makes my arm ache a lot less!

Showers:  Ugh.  Just ugh.  It is hard to shower once an IV is in because they cannot get wet.  I usually try to wash my hair and shower before my nurse gets here so I can at least enjoy one last shower before I am plugged in.  Once they are in, it is a little easier to bathe or sponge bathe while washing my hair in the sink one handed.  Because my IVs die fast I usually get a decent shower every three days with the awkward cleaning in between, which works though may not seem ideal.

Clothing: If you like to have multiple wardrobe changes a day you may get a little annoyed with how cumbersome they become here.  You cannot change shirts with an IV plugged in unless you are in a hospital type gown with snaps in the sleeve.  Honestly there are times I have thought to myself that a night gown I could step into and snap at my neck and sleeves would be great because sometimes with HG you ... well things can get messy and you don't have to be Lady Gaga to require a wardrobe change.  Be picky about what you get dressed in so as to minimize the work and energy you have to expend getting dressed if nothing else.  I have found that my IV site aches and is less effective if cold, so I try to dress accordingly and keep it covered when it is chilly.

Flushing:  I was told to flush my IV before and after anytime I expected to be off it for more than a couple seconds.  So that quick clothing change is no biggie, but when I have to drop Meatball off at school or go to the doctor I need to flush.  Do not, I repeat do NOT, force a flush.  If you screw the flush syringe on and push the plunger and are met with resistance make sure you aren't clamped (sounds simple but I have done that a million times) but do not try to push harder.  I have, and it was awful.  Hurt a lot and the IV was dead anyway.

Blood in the line:  Don't freak out.  You will, but try not to.  I have had blood back up into my line on a couple occasions.  Usually it is a sign that the pressure in my vein is greater than the gravity fed pressure coming down the line.  In other words a couple possibilities are likely: 1. My bag of fluids is too low and needs changed; 2. My bag of fluids is down too low and needs to be higher up (like on the pole, I was holding it once and blood backed up).  In either case it is easy to fix and a flush will 95% of the time push the blood back where it belongs.

Infiltration:  This fancy phrase means that the IV fluids are no longer traveling down the happy highway of your vein and have started to seep out into the surrounding tissue.  Like hikers who foolishly wader from the path, this is a problem.  I would notice tenderness and eventually look swollen when this happened.  IV is dead and needs removed.

IV site leaking:  Oh that was a fun one.  I think the nurse called it backflow.  Basically, my vein clotted off but no one told the IV line.  Usually infiltration happens with me, but twice I had a little infiltration and then I happened to notice fluid under all that tegaderm.  I have a picture here, in black and white.

See how wet it is?  It actually looks pretty good there.  That means that the saline was actually dripping out of the little hole where the catheter went in me.  Messy and sore, meant my IV was certainly no good anymore.

I cannot think of anything else to share here so I am going to call this a wrap and I will come back later if there are comments or anything else that makes me want to add more info here.  IVs have literally been a life saver for both me and baby Pinkie Pie, so while I find them obnoxious and uncomfortable the majority of the time, I really cannot complain about them.

None of this is designed to be medical advice that should replace the expertise of a doctor.  I am merely sharing my experiences and knowledge, not advising you.  I only call myself a "rocket surgeon," I have never been to medical school of any kind and would recommend you get checked by a real professional in the event you have any actual questions.  That said, if you would like me to clarify some part of my experience for you, please feel free to ask in the comments!

HG & IVs Post 2: Getting Hooked Up!

This is the first post in the HG & IVs series.  If you found this on accident, super!  Follow the links to move to the next post in the series, or head back to the intro post if you want to know what to expect in this set of posts.  If you are looking for the HG Treatment Series about subcutaneous Zofran or Reglan pumps go here for the intro post to that.  

So now we know the parts and have all the goodies for the cocktail, let's party!

A large part of the focus home health care nurses seem to have (in my experience) is to make it so that you can independently handle your medical needs.  So the official "hook up" part of the IV is the last thing that the nurse does for me unless I need troubleshooting, which is usually them telling me what to do and will be addressed in the next post.

When we left off I had all these supplies out (provided in those boxes of supplies from the home health care co in the mail) and was waiting for the nurse to come out.  Usually once she (or he, I just haven't happened to have a male nurse yet) get here they follow the same procedure:

1. Verify I am me.
2. Ask me some basic questions about my stats. (Example: What are your ketones at today?)
3. Examine my arms. (Sigh about the state of my veins)
4. Get their supplies out and sanitize their hands.
5. The poking part.
6. Blood pressure in the other arm and more questions.

Depending on the nurse and how cooperative my veins are this can take 20 minutes or a lot longer.

Before we go any further, this is one of the many I have had with a couple terms labeled.  I don't really know all the technical names for everything, but these are the terms I have heard associated with certain pieces.

IVing (yeah, I verbed that) is totally an art form.  Some are more naturally able to get a feel for veins than others and honestly it has to be dang hard.  Those who say it isn't are probably the people who are just kinda good at it naturally or have a lot of practice.

Personally, I am not bothered by needles but, that said, I cannot watch them give me an IV.  I don't look when they poke, and I really can't look if they have to dig.  I hate digging or "fishing" as some call it.  Call it whatever you want, it is torture and usually results in failure on me.

They do the poking with a needle that has a catheter on the outside of it, much like what is pictured in this post for my pump.  Only, and I am just being honest, the needle is bigger.  As in longer and thicker.  The catheter itself has a colored plastic on it that tells you how thick the needle is, they do this by "gauge."  I usually get blue, green is the biggest I have seen and yellow is used in the hands and is smallest.  I think.  Anyone reading this who knows more please feel free to comment and let me know!  Nurses seem to have a preference of their own on what to use, but I find that being assertive and saying what works for me is almost always appreciated.

Once they poke you and are IN the vein (or think they are) they will remove the needle part and leave the catheter in.  They then screw the hub on to the catheter and open the line so that fluid starts dripping.  Some will use a flush, which was in the labeled picture in the previous post.  It is basically a syringe with saline in it.

Weird fact, if they use this and get a vein properly you very well may taste it.  Yuck, but it is a good sign because it means they are in.  Either way they have to check that fluid is going in and the vein is holding.  If your vein blows they need to stop immediately and start over.  More on that in the next post.

Once they have the catheter and hub in they have to secure everything.  Every nurse seems to have a style for this, like they learn a certain way and like to stick with it.  However, some people -- like yours truly -- learn they have a certain way that works for them.  I figure since I am the one living with it I have every right to ask for it to be a certain way if possible.  I cannot use normal tape, even the paper tape that is supposed to be super gentle makes my wimpy skin react so like mentioned in this post I rely a lot on tegaderm.  Usually three sheets secures my IV without tape and gives us a spot to stick the bone, which is the peanut shaped part that holds the loop of IV tubing.  The adhesive on the bone is particularly nasty stuff for me, so it is important to rest that on something other than me if possible.

Some pictures of different placements I have had for some reference ... again in the interest of full disclosure, I made some of these black and white because if you look closely you could see some blood in the catheter/hub area.  I know that may really bother some people so I removed the color.  We will talk a little more about blood in the IV in the next post.

Once they have secured it sometimes they give me the stocking, sometimes not.  I like the stocking because it makes me feel like the IV is a little more protected and secure.  It also obscures the view of the IV a little which can help if you or someone you love has some anxiety about the IVs.

Either way usually this is the part where they take my vitals, check the baby (after 24 weeks they listen for heartbeat I am told, currently 23 weeks and haven't had that yet) and wrap up the party.  Then I just do as much sitting as possible so not to bump it or make anything not work.  Speaking of things not working, that will lead us into the third and final post of this series.  I will touch a bit on what can go wrong with an IV and when to pull it.  So check out the post HG & IVs: The Random Stuff.

None of this is designed to be medical advice that should replace the expertise of a doctor.  I am merely sharing my experiences and knowledge, not advising you.  I only call myself a "rocket surgeon," I have never been to medical school of any kind and would recommend you get checked by a real professional in the event you have any actual questions.  That said, if you would like me to clarify some part of my experience for you, please feel free to ask in the comments!

HG & IVs Post 1: The Supplies

This is the first post in the HG & IVs series.  If you found this on accident, super!  Follow the links to move to the next post in the series, or head back to the intro post if you want to know what to expect in this set of posts.  If you are looking for the HG Treatment Series about subcutaneous Zofran or Reglan pumps go here for the intro post to that.  

Before HG and regular IV therapy getting boxes in the mail was exciting.  Now, well every Tuesday my FedEx guy waits for me to haul my pole to the door so he can drop both of the 30 lb boxes inside the doorway instead of leaving them outside -- because he is nice and pities me LOL

This is the first set of stuff I got, including my pole.  Its slightly less stuff now, but not by a lot.  I get that many bags of fluids weekly.  

To begin with, I had to get sick enough that my doctor evaluated I needed fluid treatment, this was assessed at the same time I was prescribed the pump.  I know that home fluid treatment is not normal everywhere, so I am incredibly grateful (no matter how much grumbling I may do about he IVs once I have them) for the option to not need hospitalized to get the fluids I cannot take in otherwise.  Once home health was ordered IVs at home became an option that I could simletanouely utilize with the pump.  It has made one heckova difference.

I know I need an IV based on part of the info I have to check in with my nurse regularly with.  One of those stats is my ketones.  Ketones are something your body produces when it has to start eating itself to replace the calories you aren't getting otherwise.  Essentially they are a warning bell for both starvation and dehydration and you don't want ketones.  You test them with these little pee tests.

Figures, you got into this pregnancy by peeing on sticks and eagerly awaiting the color change ... why not do it the whole bloody way through?  LOL

{Side Note: They sell stuff like these on Amazon but know that brand makes a big difference.  I have another brand not provided by my home health care company and it routinely rates my ketones worse than the brand in the picture.  One is clearly more sensitive than the other, which is important to note in case you are using them and getting results that do not match your symptoms.}

So if you have anything lower than a 2+ my home health care company won't freak out.  But if I am at a 2+ or more according to the side of the bottle I need an IV.  Generally speaking, if I am well hydrated, I am capable of eating so the IV is a helpful tool no matter what.  

The IV itself has two main parts: the pole part and the arm part.  The IV pole is a slightly flimsy little cart that collapses down and has the most pathetic little casters on the bottom that don't withstand much regular use.  The pole is needed though, as my IV is gravity fed it has to stay up high so that pressure draws the fluid down the line into me.  If the bag gets too low ... well that will be brought up in the last post of the series.  The bag hangs on the pole and I control the drip rate with this little knobby dodad.  

Usually they have it set to 125, but when I first get it "installed" sometimes I get a bolus (AKA boost dose) of 165 of sometimes even on "open" for a little bit if I am really dehydrated (like if my ketones are at a 4+).

Prior to my nurse coming out to "plug me in" I get out these supplies:

Once all of those are out I just wait for the nurse they send out to come and hook me up.  The home health care company and the nurses who come actually "install" the IV provide all of these supplies.  I do not "buy" them (I am provided them and pay insurance costs) myself, technically.  Given the nature of medical care int he US I certainly pay for them. LOL

Once I am hooked up I am independent with the IV, but that is for the next post.  Click here to go to the next post in this series, HG & IVs: Getting Hooked Up.

None of this is designed to be medical advice that should replace the expertise of a doctor.  I am merely sharing my experiences and knowledge, not advising you.  I only call myself a "rocket surgeon," I have never been to medical school of any kind and would recommend you get checked by a real professional in the event you have any actual questions.  That said, if you would like me to clarify some part of my experience for you, please feel free to ask in the comments!

  

HG & IVs: Everything I wanted to know ...

Intravenous Fluids.  Before this pregnancy I had maybe 5 times in my life needed an IV?  The number was only that high because I had given birth twice and used to struggle a great deal with migraines, which often led to ER visits and occasional IV as part of the treatment.  Point being, like most people, I rarely had an IV.

I never had looked at my husband and said the words "oh this will totally be a three bagger before I feel better."  I had no idea what infiltration meant, or how many jokes I would make about "pole dancing" because why would I?  Now, now I know.

I have had more IVs than I can count.  My phone often tries to autocorrect "I've" to "IV."  I have presently been on home health care for nearly 60 days and the longest period of time in that 60 days that I made it without IV was 6 days.  My longest lasting one was 3 days, shortest died in less than 12 hours and meant I needed another one immediately.  They are lasting me less and less long now, so 2 days is really the maximum I can hope for out of an IV before it goes bad.  So we are talking 20ish IVs, easily.

Because IVs are rough on the veins of your arms/hands when they become common, I am presently being evaluated for a PICC line.  In the event I need one, I will certainly write about it too, but at present I want to just add to the HG Treatment series with info about plain ol'
IV fluids.

No pictures of me getting an IV here, but plenty of pictures once I have them and I think I have a picture of a site immediately after I removed one (yes, I did the removal, but we will get to that).

Like in the Pump Series, I am just going off of everything I think I would have welcomed a heads up on before the process started and for the sake of not being too monotonous I will break it up like this:

HG & IVs Post 1: The Supplies

HG & IVs Post 2: Getting Hooked Up

HG & IVs Post 3: The Random Stuff

So follow those links, or click here to head to post number one!

None of this is designed to be medical advice that should replace the expertise of a doctor.  I am merely sharing my experiences and knowledge, not advising you.  I only call myself a "rocket surgeon," I have never been to medical school of any kind and would recommend you get checked by a real professional in the event you have any actual questions.  That said, if you would like me to clarify some part of my experience for you, please feel free to ask in the comments!