Tuesday, October 16, 2012


This is Eli's line before it was pulled. The black
is stitches from when it was placed, but have
losened here.
 I find myself yet again trying to write something starting at 2330 hours. I am so back-blogged, I just can’t write everything I want the way I want and get to bed in time to get up on time. I have pent up blog frustration. So, Eli had his double Hickman line pulled out today. A Hickman line is a catheter that is inserted and tunneled under the skin into the jugular vein. It has two separate tubes that are held together in one covering at the entry point to the body where a cuff sits just under the skin to block infection. It was invented in 1968, but was perfected in later years by Dr. Robert O. Hickman, a pediatric kidney doctor at Seattle Children’s Hospital. It is used for giving chemotherapy, IV fluids, some medications, drawing blood for samples, and for TPN (the nutritional solution that he has been dependent upon). Each line of the catheter has to be flushed with heparin, an anticoagulant, each night to avoid the line becoming blocked with blood clotting. The continuous open wound where the line goes into the body is protected by an adhesive bandage dressing that is changed every other day. Risk of contamination and infection is a great concern as the line basically holds open a hole into the body. We have been so blessed with Eli and his line in that we have not had a line infection (had a false reading once on chemo round two), and he has only been blocked once while he was being treated in the hospital (also on chemo round two).

He's done. The nurse wrapped her fingers
around it and just yanked. It was out in a
split second, but then she had to put pressure
on his jugular vein for 5 minutes. Pressure hurts.
We were diligent with its care and it has paid off. We never one time were hospitalized in between his treatments because of a fever, which is almost always from a line infection. He was so proud to go to bed tonight without being hooked up to his TPN. It is a crutch for us though. Now, he is solely dependent on himself for his nutritional maintenance. Also, some lab samples that need to be drawn may mean a needle stick. But, still we feel a little more normal tonight going to bed without the mechanical swoosh of the pump he had to wear that pushed the TPN solution through the tubing. Our appointments took a little longer than expected today. At one point, I heard our NP saying something about coming in tomorrow. Ugh! But, partly, the delay was that our doctor had an unexpected meeting so no one wanted to commit to whether it would be pulled until the doctor had a chance to review his labs and recent history. Eli had lost two ounces since Sept. 16 (our last appointment in Memphis), and according to the HSV office his liver number was high, and his neutrophils (maybe) where high. Today his ANC (immunity count) was down to 800. At 500 he will be neutropenic , and the trend over the last three weeks is down, not up.
So, that worries us, but they didn’t seem worried about it. He wants him checked in two weeks (yikes, no Hickman!). All of his other numbers/chemistries have recovered, and they determined that the high liver number was due to him being on TPN so long. TPN by-passes the liver, and after a while of that, it starts to feel unloved and complains. So, he reasoned that he was holding his weight (?), and that his body was beginning to show signs of wear from the TPN. So, he cut him off. He wants to keep trying to give him a steroid to boost his appetite, but that’s it. So, overall, Eli looked great and he is sleeping in is bed as a little boy with no extra parts … well, except the shunt, but we might as well pretend that it is part of him. (continued… I’ve got to go to bed)

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