Thursday, March 19, 2009

Flushing The Lines

Elle has something in her chest called a central line. It's a semi-permanent fixture (it'll be there until we're done) that allows the doctors to deliver IV drugs (including chemo) and draw blood samples through one of two lines. The base (where it enters the chest) and a majority of the two lines is covered with a waterproof dressing that is changed once a week (more if she takes a bath/shower/goes swimming in a pool). It looks like a clear piece of Saran Wrap.

But these lines need to be cleared, or flushed, every day. This is so blood doesn't clot and block the lines, which would render them useless. So every day each line has to have a sterile saline solution injected into it, followed by an injection of heparin. The heparin is an anti-clotting agent that flushes any particle of blood out of the line but breaks down before it hits Elle's bloodstream, so it's perfectly safe (ie she won't become a bleeder like a member of the Russian aristocracy.)

The visiting nurses, despite their name, don't actually visit every day. Care to guess who has to learn to do this?

Beth and I each took a line today while the nurse watched us. Beth did a great job. I forgot to de-clamp my line and tried for five seconds to push the saline through before I realized what had happened.

It's an intricate process. You have to:

  • Wash your hands

  • Wipe the cap on the end of the line clean for a minimum of 10 seconds with an alcohol wipe

  • Do everything in your power not to let that cap touch anything else that occupies a point in space and time. Because if you do you have to clean it again.

  • While holding the cap at its base in one hand, attempt to de-cap a syringe filled with saline solution in your other hand. Oh, and it's threaded, so good luck.

  • Once you figure out how de-cap it without dropping the cap on the line, you take the syringe and screw it onto the end of the cap.

  • Then you unscrew it and draw some air into the syringe to break the seal and then push a little water through the top to get rid of the air.

  • Rescrew the syringe onto the cap and start to push the saline solution into the line.

  • Realize that the water isn't going through because you forgot to de-clamp the line.

  • Undo the clamp on the line and try to inject the saline solution again.

  • Unscrew the syringe from the line because by trying to push the saline through with the clamp on, you create a vacuum that you have to break. And for God's sake, do not let that cap on the end of the line touch anything!

  • Screw the saline syringe on for a third time and finally push the solution through the line.

  • Look away as your daughter, who drew her own blood the other day, glares at you with thinly-veiled disgust.

  • Repeat with the heparin.

On the bright side, I only have to do this 200+ more times over the next year. I have to get good at it at some point.

Elle had a good eating day today. Right now the goal is getting calories in her. So while I was able to get her to drink an Ensure shake made with ice cream and milk, she also had soup, vanilla wafers, Goldfish and french fries to go with multiple cups of juice. It's easily the most she has had to eat in two weeks. And she didn't have any nausea today.

She also sat on the couch watching her numerous Barbie DVDs (Barbie and the Magic Pegasus, Barbie as the Princess and the Pauper, Barbie Explains How to Sell and Buy Credit Default Swaps) and coloring with those great Crayola markers that only show up on their special paper. Her diarrhea lessened today and her fluid production was down slightly. So it was yet another good day. And that's all you can ask for right now.


Beth said...

thank you for not mentioning how I almost passed out cold when they took the dressing off of the central line...

*feeling woozy just thinking about it now*

Dave said...

You're exaggerating. I hardly noticed anything at all. Maybe just a slight blanching...

Anonymous said...

I think you both will be able to become registered nurses by the time Elle is fully recovered!

Anonymous said...

David, maybe your sister can give you lessons! You're doing great, all of you...remember you're being held in prayer...Dalia

Anonymous said...

Okay, can I just tell you guys how much I love the Barbie DVDs!

Brian O.

Unknown said...

Hi Dave, Beth, Davey and Elle-myster. Kristin is right Dave, your writing is beautiful. Thank you for taking the time each day to write this update. It helps to make me feel close, even though I am far away.

I think of you all every day with much love.


Anonymous said...

Ditto like Janie,....Paul and I read your beautiful messages of hope and laughter (Nice little spin of laughter makes it easier to deal with as you both take on this journey with Ellie together...Feeling close when we are not so close..:0) XXOO Love to you all.. I think Mom and dad are liking the stop over when they go visit you in the weeks to come..We do what we can to help.