Broviac 101

TPN is a great thing ... Manny basically slept through the night.  It was amazingly wonderful. 

The day was uneventful (like I like it). We discovered that surgery is scheduled for 9:45 Monday morning.  If all goes well (like we expect it to), we MIGHT be able to go home Monday evening.  Thanks for the prayers.   

Answering Questions (AKA Broviac 101):
I had a couple of people ask why we got the PICC when we need a Central line and also why do we still need the central line if we now have a PICC.  Great questions.  Here's my attempt to answer.

All of his doctors (here in Tampa and Gainesville) decided he needs a central line.  And we are going to get that on Monday - surgery time set and everything. BUT before then, he needs to be stable. They tried with IV but it wasn't happening and they realized he'd need to be on TPN likely to get stable. PLUS, he is
needing a LOT of blood tests over time and he has not a lot of veins. So the PICC makes sense in the short run just for all of this.

In addition, our experience has been that the PICC lines are easier to put in him than the regular IVs and less traumatic.  We are able to do it with light meds (not full sedation) and they have the ultrasound so they can truly see the veins.  They are also going into a bigger section of the vein (up high on the arm) and not on the wrist or hand like is typical of IV.  The IV nurse explained that due to his very very low tone, he has not really developed many veins that are usable.  And he has many "collateral" ones ... meaning his body is trying to make some but they are like dead ends with no blood. 

SO the real question is ... do we still need the broviac. Yes. We just don't have to have it by this Monday. The new PICC buys us some time. So there is no real reason that we HAVE to do the broviac now ... but since that was the plan, we are going to do that. In addition, if something were to happen to the broviac, there are apparently a lot better options of repair, etc. AND they told me that if something happened to the broviac, they can go back to a PICC temporarily IF the vein has been PICC free for a certain period of time. So they want to spare the precious few veins he does have.

Right now, he has one good vein and 1 sorta OK vein. They used the good vein the first time and they are having to use the sorta good vein right now. They doubt this vein will hold up more than a couple of weeks. And the repair of THAT problem is HUGE (if it "blows" the vein) and we're in another emergent situation. And to define good vein ... they want at least 2 millimeters, bigger is better.  The OK vein is less than a millimeter.  There are no other veins in either arm that are even that big. 

Finally, this OK vein is sitting "on top" (PICC nurses word for it) of the artery.  She had a hard time making sure this went into the vein and not the artery.  So any kind of injury or infection to this vein would be very, very bad.  She insisted, "Do NOT go home with this PICC."  She knows just how precarious it is because it's clear on ultrasound.

So with all that ... he needs the broviac. Like I said, not necessarily this Monday but soon and why not do it while we're already here, he's finally stable and it's scheduled. 

I've also had questions about PICC versus Central line/Broviac again.  I'll do my best to explain (while I muse on while I went the PhD route and not the MD route):
 
PICC line goes into the arm.  It's like an IV but with IV, the fluids/meds are put right there in the tiny veins on say the hands, wrist, foot, etc. and it circulates through the body. With the PICC, it's put in the upper (bigger) section of vein and then this long catheter is threaded down and near the heart where it's circulated. Unlike an IV, you can also get blood out of this vein.  PICCs are fairly easy to put in.  The problem with it: it's very hard on that vein.  So for short term use, this is perfect.  
 
But for long term use (like Manny's), it's really not a good solution.  So they go to what's called a Central Line.  There are two main types of that.  A port ... that is completely under the skin.  To access it, there has to be a needle inserted into the skin and into the port.  (This is not a great option for him since he has daily access/usage of this.  A port is more often used for things like chemo where it's only periodically accessed.) 
 
The other main option is a Broviac.  It looks a lot like the PICC but it's in the chest.  The lumen is hanging out and it's "tunneled"  (I'll give you a picture of all this when we get it inserted and all will become clear.)  We have opted for the Broviac.  Even though it's hanging out of the body, we've gotten used to that with the g tube, then two lines with the GJ and then the one with the PICC ... since we've had him, he's had SOMETHING hanging out of his body.  (Yes, it's freaky looking!) 
 
The reason to do the Central line is this is a more stable, longer option.  It still has really high infection rates and clot issues, etc.  But seriously, if you've gotten to the point where this sounds like a good idea, that tells you a lot.