Peripherally inserted central catheter

And, and for me, uh, because I couldn't...

I have a PICC line in, so I'm not supposed to lift-

Do you wanna explain what that is?

Oh, it's a, a, a kind of permanent temporary IV line that I have in me.

So when I have to go give blood work and I get daily antibiotics that my husband gives me, um, that's what a PICC line is.

Yeah.

So I, I'm not supposed to lift more than 10 pounds or do repetitive movement.

Sometimes patients don't have good veins at all, and that's really the best decision in the first place.

I have seen patients come to me from second opinions that had what we call PICC lines put in, but you're really not supposed to give chemotherapy through those.

They're really like a last-ditch effort if you really, like, for whatever

reason, you have to start immediately and you can't get a metaport in.

So I started with a mobile company for doing vascular access.

So I was placing PICC lines, midlines, and ultrasound IVs in the DMV through mostly skilled nursing facilities and some small hospitals.

Um, and I did that part-time for years.

And that was, uh, during COVID.

We could hold hands the whole way down.

I'd just have to take out my PICC line.

[laughs]

[laughs]

Yeah.

The m- the moment-

The moment you get that PICC line

... take it out, then I play.

And you touched on Even with gentamicin-resistant organisms, a common question I get when I'm talking to residents and things like that is, what about MSSA or MRSA? Gentamicin is not typically used for that.

And I think a lot of that comes into the sort of the shock and awe effect that you have of the high concentration of antibiotics, right? So we tend to think of MICs in the level of you know, systemic circulation, intravenous, PICC line, blah, blah, blah.

And the problem with that is that those concentrations are really low, whereas locally you get a totally different effect.

And I don't think that, you know, we believe that, you know, even still, but you see it just like you said in that paper they showed.

And when I compare that to where I am today, where I'm managing, I would say, safely a majority of my infected patients as an outpatient, where they're coming in, getting a good debridement, getting local antibiotics, and going home with oral antibiotics only, usually a short course just to get them to their first post-operative visit or their sutures are coming out.

They don't necessarily get an ID consult.

They certainly aren't getting PICC lines.

They aren't getting social work consults and all the things that used to really be a drag on our system.

That was back in the beginning of July.

Then she, when she got her PICC line out because she was on TPN.

So because she couldn't eat as much, the nutrition that she was getting through there kind of really filled those holes of what she wasn't getting.

And once she didn't have that to fall back on, her weight really plummeted really badly.

Creatinine guidelines for iodinated IV contrast for patients with acute renal injury.

PICC lines should really be kept clear of black bodily fluids.

Nasogastric tubes are less affected coiled up in the patient's throat.

And in quotation, my clinical judgment, I never asked for this knowledge.

Percutaneous endoscopic gastrostomy, also known as PEG.

PICC line.

Port axis for infusion.

syringe plunger, test strip, test tube, wound vac.

Ooh.

ended up with MRSA we'll just put it that way and got into my bones and as a result I was on IV drugs for about five months 14 hours a day on a PICC line and that that destroyed my gut and eventually I my vagus nerve, but I didn't know it at the time.

And for years I was eating and then I would just pass out and I wouldn't able, my body was completely disconnected.

Didn't know how to receive food or what to do with it.