Wedding Dinner Centre Pieces

therapies to prepare 2 - The central venous access: how does it fit?

before placing a central venous access, doctors monitor your blood tests, including blood clotting and platelets: it is important that bleeding from any "small holes" side to stop immediately, so your bleeding and your platelets should work fine.

First, the doctor prepares a "sterile field" means a tube that is put to enter into a large vein that goes directly to the heart, so it is important to avoid anything that may cause infection! In practice very well not only disinfects the point where it will make the sting, but a much wider area, and then cover everything with sterile drapes, leaving only the area where it should "work." Probably the drape will cover face: if it bothers you just say so. It is important that you move later, while the doctor is working!
Then there will a bit 'of local anesthetic in the area where the cannula and the points put into place. The local anesthetic burn a little 'while injecting, but after that you will not hear anything. You will hear only push, and maybe a little 'wet if it comes out a little' blood. State property, if there is any problem (you sick or itchy nose or drape bother ...) say it without moving, and avoid making deep Sigh. Note that, contrary to the veins on his arms, the deep vein in which the physician must put the cannula can not see or hear from the outside: the doctor knows where but sometimes has to look a bit '. Be patient and you will see that a procedure will be faster than you think.

After placing the cannula, we must fix it. The Hohn attaches easily, with stitches, skin, or with a special adhesive plaque (which is much better than the point!). The Groshong is "tunneled", ie it passes under the skin until it discloses, in general, in front of the sternum: in this way is much more difficult to move or remove. For the Port needs to be done instead of a "pocket" under the skin in which to put the small "reservoir" that connect the cannula, then it all ends with absorbable points, or who removes After a few days. ALL of these maneuvers are performed under local anesthesia if you say it wrong! Remember that pain is not something that "we have to endure," except for brief moments: means there is no pain! But if you do not tell doctors and nurses who have pain they can not help you.

Once placed your venous access, we will do a chest X-ray. The plate has two purposes. First, confirm that the cannula is positioned well. Also check that you have not accidentally "pierced" the pleura, which is a kind of "bag" that surrounds the lungs and holding it under vacuum "suction": if you pocket the pleura, the lung tends to collapse, more or less important (the so-called "pneumothorax"). The doctors are always very careful not to pierce the pleura, but unfortunately sometimes it can happen. If the pneumothorax is small in general is reabsorbed by itself, if it is a bit 'bigger, doctors will take the necessary steps.

If the chest X-ray is in place, congratulations! Do you have a well-placed central venous access and use, and peripheral veins of the arms and legs will thank you! Remember that these catheters should be washed regularly and heparin: that even if there are long periods when you do not do therapy or any levy you have to go every now and then to "wash" the cannula (injection of saline, sterile water in practice) and put a blood thinner, heparin, so the blood does not clot plugging the cannula. A clogged tube is unusable and must be replaced: so be careful!
Another thing to watch out for Hohn, and Groshong, is to clean the site of insertion of the cannula and the points. Not "pasticciatela" and always keep it very clean and covered with a sterile dressing, and reported to the nurse if by chance you hurt or becomes red and swollen: infections, here are a trouble to avoid. With just these few

attention and your tube will last a long time, and you will see that will make your life a patient much easier ...

Countries With Biggest Breast Size

therapies to prepare 1 - The central venous access: what is it??

After the flurry of tests to figure out everything on your lymphoma is another important thing to do: put a central venous access. What's that?? Is your best friend to do many tests and treatments ... but I only discover over time, and you will love the beginning especially if you were riddled like a sieve to make withdrawals and have spent the first few treatments with your arms still why not vein went out!

The central venous access is a tube that is put up, as the name implies, into a vein "central": that is not we see one of the veins in his arms, legs or neck, but a nice big vein that goes directly to the heart. A large vein so that its walls are pretty thick and it goes so much blood, so the drug can not damage it as it happens with the poor small peripheral veins. Usually you choose the subclavian vein, right or left as appropriate. The cannula may instead be of different kinds. Story here the most common types, which are three (may be that the name change in other parts of Italy, but I do not think), and then I will explain what happens when you put a central venous cannula. I want to clarify, if someone read the "medical field", I do not want that in my description be scientifically precise: that's why there are lots of other sources. I want to explain to those who put the cannula what to expect when I bring, what will end up on her, and the pros and cons of various things.

CANNULA TYPE Hohn

The name seems difficult? Wait for the next! ^___^
It reads simply "on", and is simply a tube that sticks out from a small hole in the skin ... unlike other catheters, however, is soft silicone, and can be used three to six months, then must be changed. In favor of this cannula is the fact that just finished the treatment takes off immediately, even on the same day. It also allows you to infuse the liquid quickly, it can be used, for example, to do the CT scan with contrast (eg the Porth no).
But the fact that "check" from the skin, you must treat it carefully, because the skin can become infected, and when you reset the immune therapies that infections can become dangerous. Also, always check it out when you want to take a shower must cover with a waterproof adhesive, and is always a bit 'a mess.
Generally the cannula that "check" from the skin is fixed with the points. There are those who tolerate them well, but also points can become infected or otherwise be annoying. That is increasingly being used a other means of "fixing", the State-lock (this is the trade name, in other places is called in a different way) which is a sticky plaque that must be changed every two to three weeks. A pleasure, if like me you have items that are infected but do not ignite. If the center does not care where you are using it to try to ask. It is a completely different life. As I said with
Hohn pay attention to the infection, but also to the fact that you can easily plug and then: always keep the medication that make you never leave the hospital and discovered the insertion point (rather than to let some dressing more to change at home, you never know), take care that the cap does not escape, because otherwise Bacteria can enter the tube and from there into the blood when it is used, it must remember that heparin (ie put in the heparin, which is an anticoagulant and prevents the caps) each week, and if you have a fever and skin red at the point of connection or you lost the cap to do this doctors and nurses.
I, being anesthesiologist (in general, these catheters are placed by anesthesiologists ... we are the experts of the bites! ^___^), Have been asked to put on the type of cannula, and the ABVD had chosen Hohn. Since I knew how to "hold" on me has lasted more than six months ... but I was a bit vex ' for points, and the inability to wash it right! Luckily it was a hot summer ... ^___^
For the reasons I mentioned, Hohn is typically used for those who must make short term therapies, or who has to put a cannula "provisional" before moving to Porth, we will see now.

PORT-A-CATH

I told you that the names were weird ... This is so strange that normally is only called "port". It is also a tube that is put into the subclavian vein, but instead of sticking out from the skin, ends up in a small "reservoir" dish that is placed under the skin, with a small cut two to three centimeters. To use it you need to pierce the skin with a needle that reaches the particular serbatoietto, which has a "cover" that can be rubber clothes many times.
Disadvantages: whether to put it is to remove it is necessary to make a cut (it's a little "work" if you want) and remains a scar (even though my scars are much worse dell'Hohn points cut in the Port ...); laundry must at all times (if you really sensitive, you can make at least one hour before a pack with a anesthetic cream called EMLA, and leave it there, is also used to make withdrawals from the kids ... I personally do not give so much trouble because I feel when the hole but then immediately goes bad), no one can infuse fluids at high speed or high-pressure, so things are looking for some other veins (eg CT scan with contrast, or the removal of stem cells, however, that I hope you do not have do), and if you have a few like me ... it becomes problematic part of the hunt to the vein! Sit back and relax and be patient if you punched several times, they are doing their best but it is a difficult game ... ^___^
Advantages: Once healed the little cut the skin is intact, so there is no risk of infection and you can have a shower when you want (even with the benefit of those around you! ^___^); addition to not require Dressings "external" heparin is less frequently (just once a month), can last two to three years ... we all hope it does not serve so long, but you never know!
I think he realized that I also tried the port, which I have right now: as I said above, my best friend for treatment, and thank you for putting it ... every time I make an infusion, and every time I shower! (Including swimming in the pool and spa ... ^___^)
For more information about the port: http://www.portadvantage.com/language/Italian/patient/about_implanted_ports.html

GROSHONG

thought I was strange names were they? But no! ^___^
Groshong (Pronounced "grosciong") is not really the name of the whole tube, but only one type of tip, which is a valve and prevents the blood to flow into the cannula, which in theory should not be heparinized. But generally it is called a type of cannula, such as Hohn, "check" out of the skin, but because the cannula is threaded under the skin and make it "tick 'a bit far from the point of insertion is more unlikely to come off accidentally, can be used as long dell'Hohn also typically has more "big" and then you can do even faster infusions. Luckily I
least Groshong I have avoided, so I can not tell much more ... My Groshong Port has a bit, but I'm not talking about it as well because you confuse.

Last hint: in some departments of oncology (do not know if the hematology) are used for those who were once called "atrial cannulae long": they are really long cannulas that are inserted in the arm and reach even the famous large veins I mentioned above (all flow into the veins there). They are very practical, but even these do not "hold" big speed and big pressure. I do not care where they are in are used.

In conclusion: I have "felt" personally Hohn and Port, in case anyone had something to ask about it ... ^____^

(Images from http://www.med.unipi.it/endochir/nutriz_parenterale.htm; http://www.portadvantage.com/language/Italian/patient/about_implanted_ports . html)

How Does Cervix Feel Just Before Your Period?

A leap in time ... My story today

I started this blog to tell my story with lymphoma was over ... I do not think so, and that's what led me to write so much: not because I did not have time, but because you do not longer a matter of telling a distant thing, but very current, which however should be true on a blog ... well, I came back the urge to write and here I am. It seemed right to anticipate something of the my story, not least to better understand where they come from my "knowledge" not only as doctor but as a patient.
So I found out I had Hodgkin's lymphoma (and resume my story here in the next post), I did ABVD cycle that in most cases leads to healing, and radiation therapy and six months after the ... TAC has discovered a recurrence. So: chemo again (after having replaced a central venous access, this time a Port-a-cath, a first Hohn) and transplantation after conditioning with chemotherapy with cisplatin and high-dose AraC (can not remember now all the drugs but write them at the time ...), but the transplant was not enough, then now I'm doing IGEV and waiting for the donor transplant
... All this time I did transfusions, lost his hair a bit 'of times, made venous access common and less common (the coax in the femoral vein for collection of stem because my peripheral veins after chemo are a bit 'disgusting ... twice), spent whole days in day hospital for coming to last but sometimes decent luck to hours, waiting for calls to the hospital, admissions made in isolation, not I had nausea when everyone has it but I also just threw up when I had to, and meanwhile they are also returned to work and I was on holiday in Sardinia, Malta and Dublin!
All these experiences from "patient" taught me so much. When I get back to work I'll be a different doctor (regardless of the limitations that unfortunately, given my work a bit 'special, I'll accept). But I'd like to share what I learned with anyone willing to read this blog. Maybe it might be useful to someone. Maybe those who know me will find something that I do not know. And maybe someone who is having similar stories will mean to her and comment ... would be nice!
Here. Starting today, two stories, past and present, will travel in parallel.