Day 273 - the catheter comes out

I'm actually writing this on Day 274. Yesterday (nine months to the day after my transplant), I had the Hickman catheter removed from my chest. It may not sound like much, but it’s even surprising me how liberating it feels to be without it. It was placed in September after the original Hickman catheter was removed because of a blood infection I got shortly after my transplant, followed by a PICC (peripherally inserted central catheter) which goes into a large vein in the arm but is only used for a couple of weeks. The catheter is used to draw blood, but the primary reason to have one is so that IV drugs can continue to be infused for a long period of time. The original catheter was used for meds in the hospital, for the chemotherapy, and for the stem cell transplant itself. Shortly after I was released from the hospital (for the second time – after my blood infection was under control), I used the catheter to infuse magnesium because my magnesium levels had been depleted by one of the immune suppressant drugs I was taking, and then to infuse saline solution because I couldn’t seem to hydrate sufficiently through drinking alone. The last infusions I got through my catheter were in early February. Since then, the clinic would get blood labs through the catheter and that was about it. The doctor left the catheter in because it was not causing problems and he thought there was a decent chance I would need it again for meds.

A central catheter requires care an attention. It is an excellent means of access to the blood stream for both meds and drawing blood, and is also an excellent means of access for germs, etc. The entry site needs to be kept clean and dry, meaning that I had to protect it whenever I showered and change the dressing three times a week, a process that took a bit of time and required 2 pairs of surgical gloves (one for removing the old dressing and one for everything after that), 3 alcohol swabs and 3 providone-iodine swabs applied in a specific way, and then a new dressing – all while diligently keeping the whole site completely sterile. I also had to flush each of the lines with heparin every day to keep blood from clotting in them and change the caps once a week. In the last couple of weeks, not only have I been feeling better and had my meds reduced, the weather has gotten warmer and I have started becoming more active with things like tennis and volleyball. More heat and more activity means more sweat and I found several times that the sweat would cause the dressing for my catheter to become unstuck which made me nervous. I therefore asked the doctor if I could get the catheter removed and he agreed.

ALERT – I’m going to get a bit graphic in this paragraph about how the Hickman catheter is inserted and was removed, so if you’re squeamish and don’t want the graphic details, you can skip the rest of this paragraph. The Hickman® catheter is made of very flexible rubber tubing that is inserted through the skin a couple of inches below the collar bone and then tunneled up to the neck, where another small incision is made so the doctor can extend the catheter into the jugular vein and thread it down toward the heart. My particular model of catheter also includes 2 cuffs just under the skin where it enters. The cuff closest to the surface was filled with antibiotics to prevent infection. The other cuff is standard on the Hickman catheter, is made of Dacron and is called by some the “fuzzy” cuff because it is like the fuzzy side of Velcro. The skin actually heals in and around this cuff so that it almost becomes part of the body. The tubing coming out of the body often is split into 2 or 3 lines (my first was a triple lumen and my second was a double lumen) and then there are caps on the end that are essentially valves to keep things from entering and exiting the body when they aren’t supposed to, and clamps that closed off the tubing except for when one wants to get something through. I thought the removal of the catheter would be fairly simple, a small incision where it entered the skin and then pull. However, because of the double cuff (and probably the length of time it was in), the doctor had to dig and cut for about a half hour to get it out. He said it was more difficult than most. It wasn’t fun, but it also wasn’t terrible painful even though only a local anesthesia was used. He said he doesn’t stitch the small hole where the catheter went in because it usually heals better without stitches, but the other hole he had to make to disconnect the cuff required a couple of stitches to close. He put the stitches under the skin and used ones that will dissolve and get absorbed, so I don’t have to go back to have them removed. When I showered today, I found that the second incision was about 2 inches above where the catheter entry was which surprised me a little. With all the digging he did, I was also pleasantly surprised to see that the second incision was still quite small. However, I also noticed that I had a large bruise around the incisions that is about 4 square inches. It didn’t surprise me much because I was actually fairly uncomfortable during the procedure from his pushing and pulling. I also realized that my worrying for 8 months that if the catheter got pulled a little too hard it might rip out a little was somewhat needless worry because I now think that it would have been very difficult to get it to separate at all from where the skin had attached.

Anyway, although I still have to keep the site dry and clean for a few days until it heals completely, I look forward to being able to shower without worrying about the catheter. I also noticed smaller benefits that I hadn’t thought much about like when I went to bed. For 8 months, I have worn a T-shirt to bed every night (I don’t normally) with a strip that I cut from the top of a sock pulled up as high as possible on my shoulder into which I tucked the catheter lumens so I wouldn’t be lying on the clamps or accidentally pull the tubing too much. Last night, I didn’t have to do that. Add all of this together with some other small benefits of not having tubes hang out of my chest, and you have a formula for a pretty good feeling of relief and liberation. It’s adding to my sense of actually getting better and my hope of getting back to a more normal life.