Medical...not for the queasy

Friday was amazing. I "bent" the lab rules a bit and did something I'm not sure was right for the lab, but I sure enjoyed it.

I was done with my floor and had gone to help another phlebotomist out on her floor. I walked into the patient's room and found the technician I'd offered to help in the elevator as she was trying to navigate her equipment.

She was a physician's assistant who was there to put a PICC line in the patient I was about to draw. She said, "This lady is a difficult stick; maybe you would rather wait till I'm done and we'll get the samples then."

Works for me. Definitely worked for the patient who was very happy at the thought of not having to be poked many times to get blood samples.

For those of you who might not know, a PICC line is "Peripherally Inserted Central Catheter". It is a line that typically is inserted into the upper arm and is a semi-permanent line that can be used for giving medicine, drawing blood, etc.

The downside to a PICC is the idiots who are supposed to be able to use them. There are a lot of PICC lines which only work a very few days because the medical staff is so overloaded with work they forget that a PICC line needs to be "flushed" regularly to make sure it - well - basically that it doesn't dry out for lack of a better way of putting it.

I say idiots, though, because IMO treating the PICC line is just a part of the medical professional's work with their patient. But, it gets overlooked - A LOT. And then we've got a patient whose insurance has paid a whole bunch for a surgery that has no use for them after a couple of days.

Anyway, before I head into my rant on ineptitude in the medical professions, I'll get back on track.

I love surgery. I wish I'd have had the science background to go to medical school way back when, truth be told. I have assisted in surgery; when I worked at the vet's office, it was pretty routine that if the vet tech was busy and I wasn't, I'd step in. And, I always insist on going into surgery with my own animals. If something goes amiss, I want to be right there if it would happen that they take their last breath for some reason. My whole family knows that if they have surgery, one of the first questions that will come out of my mouth will be, "Can I watch?" (Dammit, the docs almost always say no...but they also all tell me that if they still had OR observatories, they'd let me, so I'm somewhat consoled by that.)

Anyway, with that being said, the PA tells me that she's getting ready to put a PICC line in the patient and first thing out of my mouth is, of course, "Can I watch?"

And joy of joys, she says, "Yes, and you can even assist - let me get you some sterile stuff to put on." Oh boy, oh boy, oh boy!!!!!

So, she gets me the stuff I need, and briefly explains the procedure. It's fascinating. She uses an ultrasound to check out the vein selection, and uses a marker to notate the spot (X marks the spot!)

She then tapes the patient's arm to the bed table which is perpendicular to the bed. The table is padded with towels, and she also places a rolled up towel underneath the patient's upper arm so it is as straight as possible. The patient is awake through this procedure - in this case, she was also talking on the phone while we did the procedure!

The area is scrubbed with an antibacterial scrub, and then (my job) various syringes are filled and liquids placed in convenient spots for later use. This is a surgery, so everything is dealt with in a totally sterile manner. I help gown and glove the PA and unwrap items she needs so she can pluck them out of the sterile wrappers once she's "sterile". She then drapes the patient's arm and then puts a sterile plastic bag over the ultrasound wand. She squirts ultrasound gel on the marked site and then looks once again with the ultrasound to make sure she doesn't have to change anything.

A small clip of some sort is placed on the outside of the ultrasound wand; this will guide the needle the catheter is put through. She then injects lidocaine into the patient's arm and waits a bit till the patient feels nothing but the pressure of the ultrasound wand.

At this point she askes me to stand directly behind her so I can see the ultrasound screen. She puts the long needle in the holder, and pushes it straight through the vein walls (both sides). Once that needle is situated, she then pulls back on the needle till it is in the middle of the vein. You can see this on both the ultrasound, and also have a visual clue because the blood flashes up through the needle.

Now, some of you might think that this will be a bloody mess; true, there's a little blood, but with that long needle up above the arm as it is, the blood only goes so far. Once the needle is centered in the vein, she loosens it from the holder, and pushes it down through the vein. You can see it on the ultrasound, so you know it's being "threaded" properly. Then she takes a long wire and threads it through the needle. This sterile wire is to give the actual catheter tube a guide through the vein so it doesn't bump the sides of the vein.

The wire (in this case) is threaded thru the cephalic vein which eventually feeds into the vena cava. It actually branches; one part of the vein feeds into the vena cava, and the other becomes the internal jugular vein. (Robin, if your husband reads this and disagrees, please tell me...I'm just repeating what I was told - haven't looked it up to my own satisfaction yet!)

Once this thin wire is inserted, a catheter tube which is measured from insertion site to the final area of the vena cava area is inserted over the thin wire, which guides it to the proper placement. The wire is then removed. The catheter is then flushed out with some saline and heparin, and is then capped off. A portable x-ray machine is then ordered to the patient's room so they can double check the proper placement of the PICC. It's pretty obvious when the thing is working, but it's necessary in this lawsuit-happy age to be able to verify it with the film. (Isn't that sad? More and more expense just because we're so afraid of not having our butts covered in every possible way)

I didn't stick around to watch/help her clean up. I figured that I was pushing my luck with the lab at that point. But I told her if she saw me on the floor and needed help again, to please call me, because I'd be more than happy to help her. She was pleased and told me that they'd been talking about having a person to assist them, because it was far easier then waiting for a nurse to be available.

Guess what? I'm going to be aggressive on this one and find out which department the PICC's are ordered from and go talk to them to see if they'll consider me to be that assistant. Won't hurt to try.

Our hospital did over 1500 PICC lines last year, which averages out to 4 per day. And, there's always at least a three day delay between ordering them and insertion. Maybe an "assistant" would help alleviate that? *chuckles*

And, it wouldn't be too tough to convince me that I'm ready for a new challenge at the hospital; if I have to work part-time, then by golly, I may as well make it as interesting as I can! (And maybe they start their day a little later than I do?!)

It's good to be back - but now I've got to head for the shower so I can be ready for Craft circle this afternoon. Talk to y'all later!