14 February to 22 March 2013 – Hickman Line (Cancer and Me 24)
I may have explained already, but a Hickman line is a tube that is inserted into the chest for a few weeks, so that the nurses can deliver certain drugs more easily. The end of the tube goes into a big vein that sits very close to the heart, and the other end splits into two tubes – one for stuff going in, the other for blood coming out. I’ve included a picture, so you can see exactly what I mean.
I was quite nervous about having it put in, but looking back it wasn’t too bad. It was, however, another day off work, which I could have done without.
The reason it’s a day off work is that even after the procedure is complete and you can go home, the advice is to not drive because it can be sore with the seatbelt across the collarbone just where the line is sitting.
I had to go down to Southampton Hospital to have the line fitted. It’s done with the aid of an x-ray, and under a local anaesthetic. So you enter an operating theatre and lie on the slab, which is then adjusted into position with the x-ray machine above it. The doctor (normally an anaesthetist) makes two incisions, and pushes the tube into the vein through the one next to the collarbone. The other end of the tube is then pushed under the skin to come out of the lower incision. At a couple of points the x-ray machine is used to make sure that the tube is in the right place. Sound uncomfortable? It is a bit. It’s not something that I’d want to do for fun. But it’s over in a minute, and the whole thing is complete within about 20 minutes.
I had my line in for about 5 weeks altogether. Often patients will have them for much longer. Every week the line needed to be flushed clean by a nurse. If I wasn’t in hospital for any other reason in a particular week I had to make an arrangement for this to be done. Not a big thing (about half an hour or so), but more added hassle.
After a week or so the soreness has eased, and you hardly notice that the tubes are there. The times that they most got in the way for me were during the night in bed when they dangled annoyingly, and in the morning when I had a shower. Having a bath was not allowed, as the tubes should not be submerged in water. But in order to have a shower the tubes have to be wrapped in cling film to keep them dry.
I had to keep the line for about 3 weeks after the stem cell harvest was complete. That was because I was waiting to see the doctor in Southampton to talk about whether to go straight ahead with the transplant or whether to wait until my next relapse. If I’d decided to go ahead then obviously I would have kept the line until the transplant was complete, but in the end I decided to wait.
I believe that I have about 3 years until the disease comes back again. On the doctors’ advice I believe that when it does come back chemotherapy followed by the transplant will be my best chance of getting rid of it for good. And the doctors have also convinced me that there is no real disadvantage in waiting. A few people I spoke to (friends/colleagues) would have gone through with the transplant as soon as possible, rather than wait. Heidi, on the other hand, wanted to wait. We had holidays booked, which would have had to be cancelled (too familiar), and we were desperate for a return to normality. I felt fine, so I’d rather have a bit more time feeling fine and able to financially and mentally prepare for significant time out of action.
So the line came out on 22 March. It’s a bit more fiddly than just yanking the tubes and pulling it out! The Hickman line has a cuff just under the skin next to the hole where it pokes out of the chest. The skin binds to the cuff, by design, so that the line stays fixed in place. But that means that when it needs to come out there is a bit of digging to do to tear the skin away from the cuff. The process took about an hour for one of the haematology registrars to do in a side room, and then I had to go back a couple of weeks later to have the stitches taken out.
Well at least I know what’s involved now, so that next time there will be less new to think about.