Tyler Bailey

In Pursuit of Health and Happiness

PICC 

UNDER CONSTRUCTION

What is a PICC?  A Peripherally Inserted Central Catheter is a small tube that is like a I.V., but it is larger and is inserted into a much larger vein that feeds closely to the heart.  People who benefit from PICCs are those who will need long-term intravenous infusions. PICCS are also used for medications, frequent blood draws, chemotherapy, and parenteral nutrition.  It is basically a big I.V. that will last longer than a standard one.  Central lines (a line that is in a central vein) allows people to receive their intravenous therapy in the comfort of their own homes, too.

 

How long will a PICC last?  Typically, PICC lines are expected to last no more than four months (max!), however, with proper care and luck, PICCs can last a fairly long time.  Tyler had the same one for over a year before it dislodged and ultimately fell out.  The one he had before that last about eight months, so we know that they can function for a long time as long as they are carefully managed.

 

What can I do to help extend the life of my PICC?  There are many things that can be done to help keep a PICC functioning well.  Here are some:

  •  Always keep your PICC  and the insertion site clean and dry.  
  • Dressing changes are to be done in a sterile fashion and should be done about once a week or more, depending on the circumstances.  This is easier said than done when it comes to children with PICCs though.  
  • If the dressing becomes wet, change it immediately.  
  • Always keep a dressing change kit with you, no matter where you go because you never know when you might need it.  
  • Be sure to protect your PICC and keep it covered at all times.   This not only helps keep it clean, it also helps any damage from happening.  We wrapped Tyler's with gauze and looped the extension, so that it wouldn't dangle.  We didn't want it to get caught on anything and ultimately pulled out.  We chose to use Coban wrap after the gauze as it offered more protection and stability for the PICC.  Please note that Coban has a tendency to "shrink" over time, so if you choose to use this, you must monitor the wrap so that circulation isn't compromised.  In our opinion, it's worth the extra monitoring because it helps with keeping the PICC dry and is strong enough to withstand "yanks"
  • Keep the port covered!  Infection is a big risk factor with PICCs, not just infection at the insertion site. Those with PICCs are susceptible to systemic infection (sepsis).  Why?  There is a direct path from the outside world to the inside of the body with those who have PICCs. In fact, I have not heard of one child with a PICC line who has not had an episode of sepsis.  Tyler nearly died from a line infection on two separate occasions, I cannot stress how important it is to keep the port sterile!   Sepsis is in the top ten reasons for death in the United States.

 


These are tricky because they "clot off" quickly and aren't meant to last long.  

 

 

 

 

  I originally chose a PICC line for Tyler instead of a Broviac because Tyler had two incidents of systemic yeast and when there's yeast in the blood, all lines must be removed (tricky yeast is slimy and sticks to the lumen of the catheter, making it impossible to clear the infection completely)  And when using Broviacs, there are only so many access sites that can be used before running out of places to put it.  Tyler was still so little and I knew that we had years of TPN ahead of us, so I opted for the PICC.  
*If your baby is small enough, I found that the best way to keep it dry during bathing is to put a non-sterile glove on the arm and use lots of Microfoam tape to secure it.  I did this several times without the dressing becoming wet at all.

 

 

This page is dedicated to anything and everything about Short Bowel Syndrome. 

 Support group for parents of children with SBS and those with SBS can be found on "Yahoo Groups."

This group, that I belong to, provides a wealth of shared information from those with first hand experience with SBS.  I highly recommend joining a group if you're caring for a child with SBS because of the time saving tips and research that's all there in one place.

Bathing with a PICC line?  Here's a company to help make it easier:

http://www.drycorp.com 

Although they do not carry small children's sizes, they do have sleeves that can probably be cut down to smaller sizes and sealed with silicon glue. 

 

The American Academy of Pediatrics has a wealth of information about SBS, treatments, outcomes, TPN, etc. here:

http://www.eapsa.org/parents/resources/short_bowel.cfm

 

Here's an interesting article from Toronto about a surgeon and his practice using the STEP operation and Omegaven (Fish Oil TPN)

http://www.thestar.com/Special/article/194260

 

Medical terms simply explained:

 

Bile:  A bitter tasting liver secretion which one of the functions is to aid in the digestion of fats and stimulates the intestine to move contents through it. 

 

Bilirubin: The orange-yellow or yellowish pigment in bile.  Blood carries bilirubin to the liver where it is excreted in bile.  When the liver is unable to excrete bile, a person will become jaundiced due to the excess bilirubin circulating in the blood.

Cholestasis:  The build-up of bile in the liver that is unable to be excreted due to impaired liver function.Parenteral:  Any route other than the digestive tract, such as intravenous, subcutaneous (under the skin), intramuscular or mucosal.

Distal Duodenum:  last part of the small intestine

Enteral:  within or by way of the intestine.

Erythema:  redness

Gastrostomy tube:  "G-tube"  A tube that is put into the stomach through a surgical incision through the abdomen and remains in place.  Medical foods, pureed foods, medications and fluids are delivered directly to the stomach without the need for the patient to eat or swallow.

Hypotension:  low blood pressure.

Intestinal Perforation:  a hole in the intestine, serious and emergent as bowel contents spill into the body, causing massive infection.

Jaundice:  A condition characterized  by yellowness of the skin, whites of eyes, mucous membranes and bodily fluids caused by an excess of bilirubin in the circulating blood.

Midgut volvulus:  twisting of the bowel, causing obstruction.  Surgical emergency.

Omegaven:  A intravenous food that contains fish oil rather than soy bean oil for patients suffering from liver disease/failure that has saved many patients from liver failure and death.

 

Parenteral Nutrition:  Intravenous "food" that comes in a liquid form and is given to patients who cannot nutritionally support themselves by eating regular foods.

Proximal descending colon: part of the large intestine

Respiratory Distress Syndrome:  problems with breathing

Serial transverse enteroplasty procedure:  STEP, surgery that cuts the intestine into a zig-zag pattern to lengthen it

Sigmoid Colostomyopening of a portion of bowel through the abdominal wall, where a plastic bag attaches to catch fecal waste.