hickman vursus feeding tube

Yes, i am asking for advise on picclines, hickmans, port and feeting tube, i have to make a important decision and thought you all might have a little advise for me. picc lines are no longer an option for me, so i'm reaching out. Sorry for being confusing, im not real great with the computer, now to my first statment...
Hello, i have heard about this group and thought it couldn't hurt, right. I have some medical issues as we all do and i have to be on TPN and i have a colostomy bag, not so worried about the bag but very concerned about the tpn. I have been to cleveland clinic and the tpn through my picc line is to try and by some time. My Dr.s are stating that I need a feeding tube, but I would just rather not, if yha know what i mean? I have had 7 lines in the past year 1/2 and in the last placement they said it would be my last. I've heard about the hickman line, i think thats what it's called, and i've heard of the port. They're telling me i need a feeding tube, but no way- not for now, i mean if worse comes to worse ok, but i'm looking for an alternative, but isn't everyone i guess, lol. I'm 27 and am really looking for a safe way, just kinda window shopping if you know what I mean... I've been on the tpn since Jan. 2010, but have have had infections in picc lines and this last one is really giving me heck, just got back from a Dr.s apt and he said he will give me until Monday and hopefully my piccline will get better. If someone could just give me a little advise or their opinion, or an answer lol, muchly apr. Let me remind that I DO have to have a source for TPN and other meds that go through the line. I'll quit griping now.... Thanks you for all your help and advise!

Edited June 21, 2010 at 10:45 pm

Report post

18 replies. Join the discussion

Hi there:

Welcome to the group. You will find a wealth of information through the Oley foundation, and also through the participants on this list. Have you been to the Oley foundation website, and checked out their resources? Also, they have a conference each year, specifically for patients (and registration is free!). This year's is coming up very soon, and is in upstate NY, I believe. I have been to 2, and it's been very helpful.

I have a chest port myself, and have been on TPN since 2005. The other kind of line you are talking about is a Hickman Catheter (not Heckman).

You ask for advice or an opinion, but I'm not entirely sure exactly what it is you wanted advice or an opinion on. (For ex, you mention that your doctors want you to have a feeding tube. Is that instead of being on TPN, or in addition to? Are you trying to figure out if you should do this or not?) Let us know a bit more about what decisions you're trying to make, and I'm sure you'll hear plenty of replies.

Report post

Sorry, I agree that I'm not sure what the question is....help us out so we can help you :-)

Report post

Hi there. Like the others, I'm not quite sure what you are asking. If you are talking about benefits of a PICC line versus a Hickman, I would say go with the Hickman. PICC lines are meant to be temporary, though I had mine in for a year without complications. Then I was switched to the Hickman, which I greatly prefer. I forget it is there half the time. I am somewhat busty (38C). I make sure to buy bras that are padded (so the lumens, is it, on the ends of the catheter don't make my right breast look lumpy), with underwire support, and most crucial for me, they clasp in the front. It's made a world of difference comfort-wise. As for feeding tube, I am fed iv thru the Hickman. I have a J tube, but that is strictly for drainage of bile from my stomach. I have NO intestines, large or s
mall, except for four tiny inches of jejunem they were able to salvage.

Report post

Hey katrinakay! I think you are asking for alternatives to a PICC? If so, both the Hickman and Q-port (implanted port) are long term options. Someone else has already mentioned that PiCCs are meant for long term use but not permanent use.

I'm not sure what your insurance situation is but I know from experience that most insurances don't want to pay for continuous TPN if a feeding tube is a viable option. I have a button tube. It is very small.. looks like an inner tube blow-up valve. It's very easy to use and is small enough that I don't have to alter my lifestyle for it.

I still wear baby tees with hip huggers. Most people don't notice it except when I'm in my bikini. Then it's pretty obvious. My soution? My son (a tattoo artist) is going to place a belly button tat around it. I have a seahorse tat on my lower abdomen (to cover some of my scars). The new one will be a circle of blue waves with a tiny sea shell on one side and a tiny starfish on the other...

Report post

Woeful, Haven't heard from you in a long time - how are things going?

Lynee

Report post

As I understand it, feeding tube is safer (infection-wise) than tpn. Husband has tpn == since he can't digest enough via intestines, food must go straight into blood stream. He prefers picc because if/when it gets infected, there's no surgery involved in removing/replacing it.

He hasn't had an infection since I went to last year's Oley Conference so do go if you can -- or at least look carefully at all the things posted on this site. I bet you will find at least one procedure that you could do differently that might result in fewer infections.

Here are 2 suggestions: 1 -- alcohol wipe the rubbery part of the additive bottles -- they are NOT sterile even when just opened. (that was totally amazing to me!) 2-- get your doc to prescribe ethanol locks!!!!!

good luck
cp

Report post

As I understand it, feeding tube is safer (infection-wise) than tpn. Husband has tpn == since he can't digest enough via intestines, food must go straight into blood stream. He prefers picc because if/when it gets infected, there's no surgery involved in removing/replacing it.

He hasn't had an infection since I went to last year's Oley Conference so do go if you can -- or at least look carefully at all the things posted on this site. I bet you will find at least one procedure that you could do differently that might result in fewer infections.

Here are 2 suggestions: 1 -- alcohol wipe the rubbery part of the additive bottles -- they are NOT sterile even when just opened. (that was totally amazing to me!) 2-- get your doc to prescribe ethanol locks!!!!!

good luck
cp

Report post

Not too goof, unfortunately. My sister finally lost her battle with cancer on April 29th, the week before her daughter graduated from high school. I think I am still angriest about that. Cher always said she just wanted to live long enough to see Angie graduate. Sadly, it wasn't to be. The cancer moved to her brain and went crazy. She tried three rounds of chemo but all that did was worsen her cognitive problems. Then she started suffering grand mal seizures, it was just a mess. And whoever said you can only go 3 days without water and, what, a week without food, that isn't so. My sister went 12 days with absolutely no oral intake or food (she'd lost the ability to swallow). Because she was on home hospice, all they could give her was morphine for the pain. And the day she died, it took 7 painful hours of watching her struggle for breath. I realize how 'lucky' my father was in that regard. He took in a breath, and was gone. It was peaceful, as such. My poor sister wasn't so lucky,

aren't you sorry you asked? Lol How have YOU been?

Report post

Woeful, no, I'm not sorry I asked. I'm so sorry about your loss. I've been through that several times and it sucks big time.

Healthwise I'm doing ok-thank goodness, but my life is really upside down. My husband and the love of my life passed away in October 2009 after a drastic surgical error. He lived for 8 days and I had to remove him from life support and let him go. Most days I think I'm ok, but all the "firsts" are difficult to get through. I always had it in my mind that he would be moving on without me some day because of all my problems and I just never envisioned this scenario.

I'm learning to make it through the days and I'm thankful that I can still work to stay busy. At least I'm holding on to weight and making it one day at a time.

It's really good to hear from you.

Lynee

Report post

Get the ethanol locks!!!! I can't stress it enough. My son had a central line for 2 years and never one infection!!! Our TPN nurse said we should have been on the cover of a brochure!

Make sure you sing Happy Birthday while you rub with alchohol whipes and NO BLOWING on it to dry it off. I was told that it is disenfecting while drying. I also didn't turn on the ceiling fan or air conditioner and no humidifiers that blow warm air even when the TPN isn't running.

Report post

Lynee

I remember when your husband died. I'm still so sorry about that. You've enough to deal with without losing your partner in life :( I'd like to say that, almost 2 year later, I've learned to accept things, but I haven't. And my sister's death seems to have opened some kind of floodgate. I'm actually progressing backward, if that's possible. Extremely severe depression. Some nights it's close to midnight before I hook up the TPN because I'm just sick and tired of doing it. And I'm so sick and tired of this J tube I could scream, or rip it out myself if I had the guts (ha, no pun intended). From day one it has caused nothing but pain and various other problems. I can't remember how many diffferent tubes I've had. Part of the problem apparently is my body is seriously resisting having this foreign object in it. And as the feeding tube is used for stomach bile drainage, not actual feeding, it's constantly "in use" -- bile is constantly flowing, even though I'm on protonix to help slow it down, which it has done to some degree. But as we all know, bile is toxic. And when it hits your skin.... Which is another thing, since day 1 I have leaked and it's never stopped. My docs think because I only have those 4 little inches of jejunum, I'm just going to be prone to pain since there's always something flowing through the tube, and irritating the skin around the tube. Even saw a stoma expert, and she was at a loss. Of course I eventually developed a yeast infection because the area is never uncovered because of the leakage--pseudomonas and some other bacterial infection. Went on two strong IV drugs and both infections cleared up miraculously by day 7. Then came back with a vengeance two days later. Did another round of the antibiotics, which didn't do a thing. Docs don't want me trying any more of them because they really messed with my INR (I'm on blood thinner). And I have grown sooooo tired of every medical person who meet me going, "I've never seen a set up like that," which is code speak for they have no idea how to help. I'm sun-burnt looking raw around the tube site, and nothing helps. I've tried every suggestion on this site. I must have 22 tubes, some OTC, some script, upstairs. None work. I was able to finally find a clothing solution--yoga pants that hang low on the hips but have elastic waists and are tight (I buy petite smalls to keep them from falling off my nonexistent hips). I buy loose tops and slit them where the J tube is so the tops don't get caught in the J tube and accidentally open the tab and then bile spills everywhere (found that out the hard way). Have a few dresses big enough too, so I'm covered clothing wise. Also was able to get insurance to pay for a Rollator (basically it's a walker with a built-in seat and a basket so that I can put the drainage bag in the basket and not always have to hold it with my left hand, as I'd done for the past year and a half). But it doesn't matter. Even with the clothes and the Rollator, and the physical therapy (I have foot drop from being bedridden for so long), I still can't go anywhere other than doctor's appointments because of the pain. I'm in a pain management clinic now, and it's a joke. Last week was my third appointment and the doctor (not the one I usually see) didn't give me my usual oxycodone SL dosage but cut it by one box. This was after I explained the pain has been getting worse, I have breakthrough pain at 4.5 hours (even though I'm only supposed to take the oxycodone every 6 hours), even though I'm on a fentanyl patch. I also stressed that we aren't sure how much of the med is getting into my system even taking it sublingually because I have absorption issues because of having NO intestines. It was like talking to the wall. In her infinite "wisdom" she cut me down to four boxes (instead of the usual five) meaning I won't have enough to get through the month, so I just take minute amounts when the pain gets unbearable and I can't stop crying. Mind, never once did she, or the other doctor I usually see, ever actually LOOK at my stomach or J tube, see for themselves what is causing all the pain. I bet they've never called my GI doctor either. And they've never asked about the ovarian mass, which is also causing pain now. So I've just given up. I can't find a single person in my situation, nothing I read on this site applies to me (most people seem to have at least their colon or enough small intestine they still have bowel movements, etc., which I do not have since I have no intestine for waste to move through). I can't find a doctor or specialist who has seen someone with my setup or had a patient with my condition/setup.

And frankly I think my mother and I are playing some sort of dreaded 'waiting game.' Which of us is going to die first. She's a healthy 73, but I'm dragging her down fast, taking care of me, plus the loss of her other daughter, her granddaughter acting like we've ceased to exist, the loss of my dad. Now I won't say either of us is suicidal, because we aren't. But neither of us care about living anymore. Because we aren't. We're just breathing each day, praying something worse doesn't happen. She worries if she dies first, who will take care of me, though I know she also doesn't want to be the last one "left" if I die first. And I worry if she dies first, the grief will be overwhelming (I'm superclose with my mom), I'll end up in a nursing home, and I'll be the last one left. No matter how you look at it, it's going to come down to one of us being left alone. And it plain bloody sucks. So I've just stopped basically. Oh, I still take all my meds and TPN and protonix and zofran and lorazepam, but otherwise, I go to bed at night, sleep about 2 hours at a time. When my TPN goes off, I disconnect everything and either go back to sleep or watch TV in bed, or come downstairs and sleep on the sofa and watch tv. I've said it before to my surgeon and I'll say it again. In their efforts to save lives, and I know they are upholding their Hypocratic oath, do they ever stop and think what are they actually SAVING? Just keeping someone breathing is *not* keeping someone living. There is a difference. If it weren't for my mother's sake, I wish they would have just let nature take its course.

Sorry to be such a royal downer. That's why I stopped posting. I just don't have anything positive to say or offer, and I don't want to upset people who are new to all this. Some people have amazing coping skills. Some people find ways to overcome their obstacles. I've found out that for whatever reason, I've been unable to. And like I said, since my sister's death, I just flat out don't see the point anymore.

Report post

I have a hickman and am very happy with it. i had a picc line for 8 months, but the dr said it was temporary and can get infected easier, and recommended the Hickman. I was really afraid to get the Hickman, mostly because it meant more surgery. But the surgery was easier than I thought, they put me in 'twilight' sleep, and it only took about a half hour. I was sore for a few days, and it took about 6 weeks to heal, but once healed, I didn't need any more bandages, which also meant I didn't need a home health nurse anymore. Now people who don't know me, don't even know I have it. It's totally concelled. And no more bandages. I even shower with it. the only time I need to bandage it up is when i swim (chlorine pool only, no lake water). The hickman has given me a lot more freedom than the picc line. I would never want to go back to the picc line again. (check with your dr. about not needing bandages, some dr.'s prefer you still need to bandage it) Good Luck!
U3feet

Report post

Katrina,
First off dont let the drs scare you about TPN. Its around for a reason. To give nutrition to those who cant eat. I have myself been on for 22yrs and I am well & still going. I get mine tpn through a hicman....my current line 7 yrs this month! I have also had many PICC lines, and 1 port...but hated that! If you have to be on TPN long term then I would suggest getting a hicman.

I also have a Jtube that was originally used for feeds but now only for meds since I cant tolerate feeds any longer.

I would suggest that if you can tolerate foods then get the J/G tube along w/ the hicman for times of bowel rest!

Report post

sorry, yes, and i guess i haven't come off very well, but i have edited the original question, all and any advise or help would be great.

Report post

Thank you all so much for your help! Those picc lines don't give you much of a chance against infection even if your a neat freak like i am, gotta have the gloves, antibacteria, all of it, i wipe my tables and all of it alot! My husband thinks i'm gonna scrap the stain of some of our furniture, lol! Again thanks you for all of your suggestions, Krisper and under3feet, that's kinda what i wanted to hear. And Krisper you have been on it along time for you I feel for yha, both of yha and i hope things are going well in all of your lifes and thanks under3feet, i'm trying to teach my 4yr old how to swim, so that news is exciting to me(swimming wise). I also have an auto immune diorder so i''m sure they'll probably want me to dress it away, lol/ Anyways, thanks again, hope to hear form you all soon :)

Report post

Hi there:

I agree that you should not be afraid of TPN. It's a survival mechanism for many of us, and I personally have no complaints under the circumstances. However, with that said, if you *can* use your GI tract, you always should. If you can survive on a feeding tube, I can't imagine a medical professional that would not require that you do that. I had to try J tube feeding for a several months until it became clear that this was not the answer for me. The extent of my malabsorption problems became clear when they were pumping me full of tube feeds, and I continued to lose weight.

As has been said here already, tube feeding is safer. Because the tube is going into your intestinal tract or your stomach, you are not prone to the dangerous blood infections that you are exposed to on TPN. It's hard to tell from your post, but if there's any possibility of being tube fed, I suspect your docs are going to give it a shot, right?

As for the various types of lines, everyone has a type that they prefer. It depends on your lifestyle, how often you're on TPN, how comfortable you are accessing your line, etc. Because I wanted to be able to be without the tubing hanging out all the time, and b/c I wanted to be in control of accessing/de-accessing, and wanted to not have restrictions or worries around hot tubs, pools, bathing, etc. - I chose a chest port. It was the right choice for me. I have had no infections (knock wood).

Good luck.

Report post

I have TPN and a G-J tube. The tube feedings (if they work -- I am not able to tolerate them, unfortunately) are actually less intrusive than the TPN, and I wish that it had worked out that I was able to use the J tube for my feedings. I would happily exchange J-tube feedings for TPN. What are your reservations about the J-tube? Maybe we can help with that. I've had some nasty infections in my PICC line -- one bacterial, one fungal -- and would just as soon get rid of that source of potential infections.
Good luck making your decision. Candace

Report post

well, i have a neighbor whose had five of them and i've heard so many people say that they'd rather stay on tpn, rather than the jtube. I've done okay with picc lines, they don't bother me until i get an infection, i guess i'm just waiting for this miricle answer to appear so i don't have to keep going with the tpn or the illeostomy, but so far i belong on the "mystery diagnoses show", lol. But so far this tpn and the picc line has saved my life, i'm sure thats what it has done for all of us or we'd be eating all the great stuff, but anyways, i just don't think mentally id be able to deal with a feeding tube, although if that's the decsion i have to make, well that's what i have to do but so far they're giving me an option, seeing how i'm 27 and all. Just the thought of having one i guess, I've had 2 feeding tubes through my nose as well, and there's no way i'd do that again, not for fun anyways. I've done a little research and it seems as if you don't want the j tube, it kinda runs down the line, which i could be totally wrong!: picc, hickman, port, jtube, so i think mentally in my mind i'm trying to do things less invasive before i have to actually get a feeding tube, it sounds silly doesn't it. Thank you all for you advice and keep it comin if you have anything to comment on. Thanks so much

Report post

This discussion is closed to replies. We close all discussions after 90 days.

If there's something you'd like to discuss, click below to start a new discussion.

Things you can do

Support the Oley Foundation

Help the Oley Foundation reach its goals and support people like yourself by making a donation today.

Donate to the Oley Foundation

Discussion topics

Helpful links from the Oley Foundation

Community leaders