Peter's new PICC

The week before Christmas Peter needed to have his monthly labs drawn from his PICC line. Routine labs, routine procedure. Not this time. This time the PICC would not give more than 2mL of blood for labs and we needed about 20mL. So after some talks with the homecare nursing team and Children's Boston, we agreed that Peter's line could be tPA'd in the home setting now that he is bigger and no longer having active bleeding episodes that he had in the past. It was successful, got the blood needed for the labs, and then the line stopped flushing completely, and upon closer inspection, it had little particles floating in it. Everybody's guess is that the hard crystallized build up that we have seen in the line since last Feb, must have reacted with the tPA and started to flake off. Ugh! Since he has a dual lumen PICC, we decided to use the other lumen for his TPN and to get the line replaced. Monday the 21st of December we went to CHOP for a replacement PICC. It was just to be another rewire, which should be a reinsertion of a guidewire into the old PICC, removal of the old PICC, and then insertion of a new PICC over the guidewire. It should just take an hour once he goes into Interventional Radiology. We have had this done a few times now. Well, things started by a delay of three hours before even getting taken into the IR room, but no one telling us that the delay was that long. We kept being told we would be going there shortly. Three hours of keeping a wiggly four year old entertained is exhausting, and there was me AND one of Peter's nurses there! Then once he had been in IR for well over an hour and we still hadn't heard how things were going, I asked the nurse. She called IR and then they told her that the IR doc was in the process of placing the PICC line into the other arm because the rewire had been unsuccessful. When Peter was brought to the recovery room, we were told by the doctor that she had tried very hard to rewire, but the vein that the PICC had been in started spasming and was narrowed, so it was time to give that vein a rest. Poor Peter had to be given more sedation for that longer procedure though, so we ended up staying at CHOP until 8:30 that night and were the last to leave the IR recovery area. He was beside himself on the ride home - tired, and very thirsty. None of us even thought about his fluid replacement over the day other than a 300 mL bolus of normal saline during the procedure. Fortunately we had some Pedialyte to offer and were able to pick up more at WalMart on the way home.

Now for the real bombshell... the new PICC line has a LEAK!! At first I thought I was just being careless and getting Peter wet when flushing the line. Then I thought that perhaps the cap was faulty. Finally, we took a long hard look at it and unbelivingly, watched a drop of the flush solution drip out of the line as we flushed it. We flushed again, and there was another drip of solution. We took off the dressing and found that the dressing edges were wet from this leak, and the stat-lock was holding little droplets of fluid inside. The 'good news' is that only one of the two lumens has a leak, so once again we can give TPN until we can get a new line put in. Boston agreed to our request that they redo the PICC for us when we are up there again for Peter's intestinal rehab visit. Meanwhile, the red lumen with the leak is clamped off tightly, to be unused and unflushed until we replace it in a couple of weeks.