PICC Line at work?

I was just discharged from the hospital with my 2nd PICC Line. With the first one I developed a blood clot, so now I'm on Coumadin long term. This most recent hospitalization brought me up to 45 days inpatient since June. I have Eosinophilic Colitis, Factor V Leiden, malnutrition and GP. I'm on 11 different oral medications now, as well as 24 hour TPN.
I've missed more days of work than I've been there this year (I'm a 3rd grade teacher). I want to go back to work, but I'm not sure if I can. The doctor at the hospital wrote me a note to return to work in about a week, but I'll still have the PICC and I'll still be on Prednisone, which decreases the immune system.
I do feel somewhat stronger with the TPN, but elementary schools are so germy, that I fear infection. Hopefully, the TPN will be cut back a little to less than 24 hours by then, or going back will be near to impossible.
Does anyone have any suggestions or ideas on this question? Thank you.
--Deb

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If you do go back while still on TPN, you could always wrap the site in an ace wrap or something if you're worried about it getting infected from the kids, although the dressing should be good enough. Also, the ;arge bottles of sanitizer are great as well.

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Yes you do need to be very very careful of not getting the site infected, I have been there. Also be careful the line some how doesn't get tugged on.

Be careful wish you well.

Desiree

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Hi Deb,
Have you contacted OLEY for the phone number of the HPN support person of the month? It's amazingly helpful to be able to talk to someone "in person" who's BTDT and can give you suggestions and support. There are some amazing people out there who have done everything from parasailing to mountain climbing while infusing TPN, which certainly helped calm my fears about cooking supper or grocery shopping while hooked up! Check the website for the toll-free number for the volunteer this month.

I've had my current PICC site for over 3 years. I've been on 24hr TPN and 24hr J feeds the entire time. I use TubeGauze to keep the site held together (double lumen with extensions) when I'm wearing long sleeves, but if I'm wearing short sleeves I have my husband wrap the site in coflex (the latex-free version of Coban, a self-adhesive wrap.) (The co-flex wrapper has this website on it: www.andover-healthcare.com) I have always threaded the tubing up my arm, down through a sports bra (more comfortable accommodating the tubing than a regular bra), and out of my shirt at the waist. I use a CADD prism pump, but have had several "close calls" with lines caught and almost pulled in the 6+ years I've been on TPN, so I add an extension of "Vygon Lectro-Spiral" tubing (curly tubing like a telephone cord) at the end of the CADD tubing, between the pump and my line. Here is the info: http://www.vygon.com/en/products/products.php?fam_id=639&prd_cde_movex=0011 5560&PHPSESSID=1a2505a0bb30d470f3661aee152c0733

I'd be far more worried about the viruses the kids are passing around than the line. If you haven't already, look into getting a flu shot and pneumonia shot. Definitely buy a king-size bottle of Purell, a giant can of Clorox wipes, and a box of non-latex gloves to use in your classroom. I've found that it doesn't matter if I'm infusing or not infusing away from home, but if I have to do any accessing or de-accessing away from home it makes me a little nervous. If you have to infuse any meds while at work, find a place where you can sanitize all surfaces that you'll be using, can be alone so no one contaminates your area, etc. I hate accessing my line away from home, but people do it all the time and avoid contamination with good planning and awareness.

Good luck to you Deb, please let us know how you're doing!
Take Care,
Heidi

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Thank you, All, for the advice. I'm written out of work for at least another week, and when the visiting nurse came yesterday, she was firm on her feelings that I should not go back to work with the PICC line. She had a good point. She stressed that my resistance for infection is so low right now, that placing me in a situation with so many germs would be asking for trouble.
I will see my GI doc, hopefully, early next week, and she will have to make the decision.
Thank you, Heidi, for all that info. I am very interested in the Coflex wrap. I am allergic to most, if not all, of the tapes, and have developed a rash all around the PICC site. The visiting nurse has ordered me some special dressing, but it hasn't come in yet. In the meantime, I just tuck the extensions into my sleeve.
Have you found a product that keeps the site dry during a shower? I bought something called a " Shower Sleeve" at CVS, but it does leak. I've tried wrapping it, but it's in my right arm, and I'm right handed, so that's near to impossible to do well. Any ideas? Thanks:-)
-Deb

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Deb,
I have a PICC where I run TPN 12 hours nightly and I also have a J-tube where I feed 14-17 hours a day. To keep the PICC dry when I shower I wrap it in Glad Press and Seal then I slide the bag the TPN comes in up and over the Glad Wrap and tape the bag to my skin. It usually keeps my arm dry.
Good Luck

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Hi Deb,
A few years ago, I almost lost a perfectly good PICC line because I couldn't keep a dressing in place because my skin was coming off in sheets and the entire area looked like a bad 2nd degree burn. Since I'm going to need IV access from here on in, giving up a spot is a really big deal. My pain Dr. is the one who came up with the magical solution: Kenalog aerosol spray! It's a topical steroid but since it's sprayed on, it dries completely and doesn't keep the dressing from sticking the way ointment would. Here's the info from the can:
Kenalog Spray, Triamcinolone Acetonide Topical Aerosol USP by Ranbaxy of Jacksonville, FL

This is my PICC dressing routine:
~Pre-medicate with IV benadryl 1/2 hour before the dressing change
~Take off old dsg, scrub with chloraprep, let dry
~Spray entire area with Kenalog spray, let dry
~Spray with Cavilon no-sting barrier film, let dry (not the little wipes in foil packets, the pump spray by 3M so I don't accidentally wash off the kenalog)
~Put a small IV3000 near the site and the Stat-Lock goes on top of it. (I react to both the standard and the pedi stat locks, but the adult version has duoderm in it and that causes a systemic allergic reaction, not just a bad skin reaction like the foam adhesive.)
~Put a biopatch over the entrance site and cover with another small IV3000
~ Put a folded 2x2 gaize sponge under the clamp and the "joint" between the PICC line and the extension tubing so there are no bumpy parts touching my skin
~Put a medium IV3000 over the entire thing
~Secure the other lumen as well as a generous stress loop with tube gauze or co-flex, depending on what kind of shirt I'm wearing and what I'll be doing.

I'm always nervous trying new dressing materials because I've had anaphylactic reactions to latex several times, even when the latex never even touched my skin! When I have a tunneled line I can get away with a teeny tiny dressing, but the PICC needs to be anchored and I form scar tissue like crazy so sutures are out of the question. For a while I anchored it with steri-strips but it wasn't a very strong hold, so I was relieved to discover that IV3000 was OK when I spray my skin with Kenalog first. Co-Flex does a really nice job holding everything in place. I get different colors to match my clothes. :)

I have a DryPro PICC cover that's completely waterproof. I can even go swimming with it on! (Obviously, I need to be completely disconnected from everything in order for the cover to get a good seal.) I think it cost around $40 but it was money well spent. www.drycorp.com

Take Care,
HeidiC

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