-I'm glad you're getting a PICC

[Guest guest]

Hi ,

If you are going to be getting Rocephin, then you will have a Peripherally

Inserted Central Catheter (PICC). I think I've mentioned to you before my

concern about your PICC placement method.

I don't know how they do things in California, but here in New York a good,

specially trained IV nurse can insert the PICC, using the anatomic landmark

method, usually in a hospital or sometimes in a doctor's office.

After that is done, before the first infusion, the patient usually has to

have to have a single chest x-ray to make sure it's in the right place.

Usually it's in the right place.

But sometimes a PICC will curl up inside the vein or even go up into the

neck. If the x-ray shows the catheter isn't in correctly, they'll probably

pull it out and then they might send you to radiology so a surgeon can

accurately place the PICC using fluoroscopy. I'm writing to you about this

so you can think about it ahead of time, and decide what you would do.

Here's a BMJ article (and very interesting reader responses) that discusses

fluoroscopy, among other x-ray techniques.

http://bmj.bmjjournals.com/cgi/content/full/327/7411/371

In this study, 130 physicians in the U.K. were asked to estimate the

radiation dose received in a chest x-ray. Not one of them came close!

Furthermore, only 6% of them knew that a CT scan of the abdomen involves 400

times the amount of radiation exposure as a chest x-ray.

Not one of them (and this included radiologists) knew that an arteriogram of

the leg involves 400 times the amount of radiation.

When they were asked about Magnetic Resonance Imaging (MRI) of the abdomen,

knee and spine, 8% erroneously believed that MRIs involve radiation. (I

believe the people on this list would have done better than those doctors.)

Finally, 5% thought that an ultrasound of the abdomen involves radiation.

The 130 physicians who filled out questionnaires on this topic were 40

senior house officers, 40 specialist registrars, 40 consultants, or 10

consultant radiologists. Yes, consultant radiologists.

So who knows how much IR you would get during a ten- or fifteen-minute

fluoroscopy for PICC placement? Is it 400 times the radiation in a chest

x-ray? I queried radiologists at a question-answering website, and no one

answered.

THE GOOD NEWS

There is a safer way--ultrasound-guided placement.

The August 16, 2003 British Medical Journal has a meta-analysis of

ultrasonic locating devices for central venous cannulation.

http://bmj.bmjjournals.com/cgi/content/full/327/7411/361

The study found that catheterisation under two dimensional ultrasound

guidance is quicker and safer than the landmark method (used by nurses) in

both adults and children.

It also concluded that two dimensional ultrasound guidance is more effective

than Doppler ultrasound guidance for more difficult procedures.

So, , I hope you can google around and call around and find a hospital

that uses 2D ultrasound for PICC placement. I don't know anyone who has

used it and I have no idea how common 2D ultrasound placement is, but it

might be worth the trouble for you to find out, in terms of your long-term

health. Or if you have your PICC placed by the landmark method and they

mess up, maybe they could just pull it out and try the other arm before

sending you to fluoroscopy. (Pulling it out is not painful.)

In any case, I'm delighted by the report from your new doctor. Once you've

got the PICC maybe you can push a couple of grams of glutathione into it

every day. Medical probably won't pay for GSH, but they'll pay for the PICC

insertion and nursing care, so you might as well get double use from it.

The GSH in itself might do wonders for you. I have a friend with breast

cancer who got IV GSH along with her chemotherapy. I don't know if any Lyme

doctors are using it with antibiotics now, but I wouldn't be surprised.

Sue ,

Upstate New York