PICC line and pseudomonas

Well, Emily's dang ulceration is infected again. A few weeks ago, it was e.coli and pseudomonas. Emily was on Cipro, which seemed to clear it up. About a week ago, the ulceration started to have a nasty discharge and smell again. Dr. Gould cultured it and it came back as pseudomonas again!! And this time, it is resistant to every oral antibiotic there is, including Cipro! Dr. Gould called Infectious Disease to see how this is possible... How she could have pseudomonas that is susceptible to Cipro and then two weeks later, again get pseudomonas resistant to Cipro. They said that unfortunately, this strain of pseudomonas changes quickly at the cellular level and also quickly develops resistance.

Great. The only options that we had the first time were Cipro and IV. Now that Cipro no longer works, our only option is IV antibiotics. Dr. Gould said that for the administration, we could either do a peripheral IV line or a PICC line.

The advantages of a peripheral IV line are that they are pretty easy to place, easy to maintain, easy to administer through. MAJOR disadvantage - they don't last long. Most likely, maximum 2-3 days. This would mean that Emily would have to be held down and poked 4-5 times during the 10 day treatment (assuming we could get them to last that long).

The other option was a PICC line. A PICC line is a Peripherally Inserted Central Catheter. A PICC line is inserted into a peripheral vein but then is advanced towards increasingly larger veins, toward the heart until the tip rests in the distal superior vena cava in the heart (thanks, wikipedia). The advantage of a PICC line is that they can last a long time - months. Disadvantage - Emily would have to be sedated for placement.

After weighing the options, we decided to go with the PICC line. Emily would have to be poked much less frequently (hopefully only once) and she would be sedated for that. Dr. Gould made an appointment for us at the Rapid Treatment Unit at PCMC for 11:00 yesterday for placement.

Yesterday we arrived at PCMC, registered, and were taken to room 105 in the RTU. Emily's vital signs were taken and an RN specializing in PICC lines came in to discuss the procedure. The on-call doctor (Dr. Sandweiss) then came in to talk about Emily's case. Then two RN's from the IV team and another RN came in for the placement. A regular IV was started in Emily's foot and she was given meds for sedation (Ketamine). It was really weird... Emily got really sleepy and out of it but never closed her eyes. The procedure is done in a sterile environment so we all donned masks and the RN doing the placement wore gown, hat, gloves, etc.

After a couple tries, the PICC line was in her upper arm. They were really hoping to get a bedside x-ray to confirm placement before they stitched it in but the bedside was down. So after it was stitched in, we went to radiology for an x-ray to confirm placement. Bummer - the line was flipped up in her neck instead of down into her heart. Back to the RTU we went. The two RN's came back and power-flushed the line hoping to get it to turn. Back to x-ray. Bummer again - still flipped.

Since Emily had already been sedated once, they didn't want to sedate her again that day. So for now, the PICC line can be used as a regular IV line. They said that sometimes it will flip on it's own, so we go for a chest x-ray on Monday at Mountain West. If it still hasn't flipped, we have to go for replacement under fluoroscopy. Dang it - it couldn't have been easy.

The home health nurse came today to show us how to administer the antibiotics. Emily is on Ceptaz (Ceftazidime) every 8 hours for 10 days. The infusion runs on an IV pump over 25 minutes. Right now, the schedule is planned for 6 a.m., 2 p.m., and 10 p.m. Yuck. Luckily none of it hurts Emily but it sure is a pain for all of us. She doesn't like having to be held and not touch anything.

The timing works out well... She will be on antibiotics until the day before the surgery. Brave little Emily has been so good and so patient.

What are you going to do to me?

(PICC line wrapped up on right arm)

Being checked out by the nurse

The infusion pump and supplies

Happy to be done!

I so love this sweet girl...