Day 38, Thursday, March 7th, 2013

Today was yet another in a continuing series of days where I was tired and essentially did nothing. The reasoning for this is simple: I am recovering from surgery, multiple days of GCSF injections, and two days of apheresis. These are the sorts of things that tucker a body out. In addition, I continue to have very minor bleeding from my Hickman line, which, I am told, is actually fairly common, especially with the specific type of line that I have; the access ports, or 'claves' that are outside of my body are short, and the line that enters my body is of a heavy gauge, making the whole line difficult to clot around and prone to movement. 

The Hickman line is a semi-permanent intravenous access line; you may also hear them referred to as central venous catheters. This one goes in on my right man-boobie, runs under the skin and up over my collarbone, then inserts into my jugular and down through into the superior vena cava, emptying in the highly turbulent zone just before the right atrium. This turbulent flow ensures good mixing, and, of course, having fluids dumped straight into the heart ensures fast and near-uniform delivery to the rest of the body. Patients who will be getting a lot of blood work done (including frequent drawing of blood for diagnostic reasons, apheresis, dialysis, or chemotherapy) often get this sort of thing installed. I am happy to have the venous kind of catheter, and not the kind that goes up your doodle. Doodle catheters scare me a little. I am aware that they are for different things.

If you've been following along with me since last August, you'll know that I had had a PICC line installed in my right axilla (underside of the right upper arm, where the arm meets the shoulder joint). This was a different sort of semi-permanent line (fun fact: when they pulled the PICC line out of me, there was about a foot and a half of blue line that came out with it). The Hickman line has many advantages, including a higher throughput capacity, greater stability and freedom for the patient, and, in this case, is actually divided down the tube into two separate lines, which allows two compounds to be added at the same time without mixing outside of the bloodstream, or for blood to be drawn at the same time that I am receiving fluids (which is extremely handy for apheresis). The greater stability and freedom comes from the cuff on the Hickman line that the body actually grows onto, securing it quite firmly.

Any sort of long-term access line requires frequent, usually daily, flushing with saline, in order to keep it flowing and free of infection. Once flushed, the lines are usually partially filled with heparin, an anticoagulant, in order to greatly reduce the formation of clots inside the line. The dressing on the line is usually changed once a week, and requires special covering while showering, with some sort of waterproof barrier. Because of the bleeding that I have been experiencing, I have been getting gauze dressings that are swapped out daily (To prevent infection. Blood is an excellent growth medium.), until the line settles down. I have been taking it easy, in an attempt to facilitate this healing process, which is what I am damned well supposed to be doing.

"I've found Jesus! He was behind the couch all along!"