PICC Line Woes

I found myself wondering today why we couldn't just catch a break with all this PICC line troubles. Joaquin was scheduled to have his xenopax infusion at 7:30 a.m. and when I went to flush his PICC line last night before bed I noticed that fluid was seeping from underneath the dressing. No good. I was hoping and praying that it would work but knowing deep down inside that wouldn't be the case. I just knew that it had finally bitten the dust.

And I was right. We had one fleeting glimmer of hope that it was flushing properly with no fluids seeping out but then we saw it. The nurse called the PICC team to come down and look at it. It was the same nurse who had dressed it before we left the hospital after our last visit - her plan was to undress it and then try and pull it out a little. Her thought was that perhaps a little fibrin - which is the body's natural defense to foreign object and forms a coat over the object to make it more like the body - was causing the problem. She thought that by pulling out the PICC line a little bit (because we can't push it in for concern of contamination and infection) it would loosen the fibrin and allow the PICC line to work again. Or, the other problem could be that his vein is just shot. The later turned out to be the case. Around noon the PICC nurses came down to remove the PICC line and place an IV so that Joaquin could receive his xenopax infusion.

I didn't know that it would be so difficult. The tried twice to place it and both times they had no luck - his veins were just too small. They called Dr Wong to tell her and when she arrived we had to discuss the possibility of another surgery to place a better PICC line that would be performed by surgeons but would also involve anesthesia. Chris and I had discussed this before because they mentioned it while we were in the hospital last time. We had decided that we did not want to have the surgery. Joaquin only has about five or six more xenopax infusions. He's also at a point where his Prograf is remaining steady (yay!) - which means less blood draws. But the problem with placing an IV so that we could do his mandatory and very important xenopax infusions could mean we might have to consent to the surgery.

The nurses had been eyeing the veins in Joaquin's little head. They thought that they saw a good one along the side of his head. Dr Wong left and said that if they could place the IV today then it would be two weeks until the next infusion and then we could discuss our options again at that time or if it was not placed today then they would go ahead and start making the arrangements for the surgery.

After Dr Wong left the PICC nurses turned to me and asked what I wanted to do. I asked them if they felt confident in trying to place the IV in his head and if that was a good shot. They felt like it was although she said that she is never too confident placing IV lines in little guys like Joaquin. She said that parents just didn't usually like seeing their kid with an IV in their head! At that point I didn't care because the IV would be out in about an hour anyway so no one would even see him. I said that we would give it one more shot and if it didn't work we would be done. And we finally caught our break. They were able to place the IV line and he was able to receive his infusion. I wish I would have had my camera with me because they had to put a little mesh cap-looking thing that was open at the top which made his hair stand up. He looked so funny! If having an IV in Joaquin's head means no surgery, I think I can deal with the minor aesthetic aspects of it.

After he was well on his way to be infused, Dad and I left to go find some lunch. When we got back Mom said that Dr Alexander had been in and he asked about the PICC line and Mom said it was out and he said good. He felt like we would be able to get by without another PICC line as long as they could get an IV. Like I've said before, it good to hear Dr Alexander say that because he's one of the main doctors on the renal team, very experienced, and only has Joaquin's best interest at heart.

We arrived back to the RMH late in the afternoon feeling relieved that we had mad it through the day without having to schedule surgery. Now it was time to await the blood test results from this morning's labs. It's like I would love to relax and feel good about everything but we also had to see if his Prograf level okay. And it was... So we don't have to have labs drawn tomorrow!!

Tomorrow we plan on driving up to San Francisco and go to Fisherman's Wharf. Dad has never been there and Joaquin wants to go bark at the sea lions. I also enticed Dad with the prospect of clam chowder in a sour dough bread bowl. He's never been to Fisherman's Wharf or San Fran except to fly in and take a bus to Palo Alto last summer. And then Chris is driving down tomorrow with some friends to go to the Roger Water's concert at Shoreline Amphitheater in Mountain View, just a few miles down the road from Palo Alto. We received the tickets from a friend as a wedding gift and we are looking forward to it and spending some time during the week together. Grandma and Grandpa are looking forward to babysitting!