Lung Cancer - Diagnosis

Timely diagnosis of lung cancer is crucial for a sound prognosis. Here are the different ways by which a cancerous growth in the lung is diagnosed.
Cancer of the lung is not the easiest to diagnose in its early stages, primarily due to generic symptoms that could be mistaken for any other respiratory disease. Another hindrance in timely diagnosis is the patient himself/herself, who blames his/her own lifestyle for the 'side effects', and avoids timely diagnosis. However, it's not all bad news for lung cancer patients - early diagnosis can result in an effective treatment with cancer-free years ahead.
When Is Lung Cancer Suspected?
The initial diagnostic tool is a physical exam that may lead a doctor to suspect the disease. The following signs may point towards cancer in the lungs:
• Abnormal lung sounds
• Swollen lymph nodes over the collarbone
• Weakened breathing; face swelling
• Arm weakness
• Enlarged veins in chest, neck and arms
• Drooping eyelids, differently sized pupils
Based on the results from the physical examination, the doctor will ask the patient to undergo the following tests:
Imaging Tests
1. X-ray - An x-ray can show a large mass or nodules(s) in the lung.
2. CT scan or MRI - If the patient resents more severe symptoms, the doctor will directly order a CT scan or MRI of the chest to identify the problem. These tests create 3D images of the chest and are more detailed than an x-ray as they can reveal the size of the tumour along with the stage of cancer. They can also tell if the cancer has spread from the chest to the lymph nodes or other organs.
Tissue Or Fluid Studies
If the above tests reveal cancer-like mass in the lung, the doctor requires confirming diagnosis by studying the lung tissue from fluids. There are different tests for this purpose:
1. Sputum Cytology
Persistent cough brings up sputum, which can be looked at under the microscope as they may contain cancerous lung cells.
2. Bronchoscopy
A bronchoscope, which is a thin, flexible tube with a tiny, lighted camera at its tip, is inserted through the mouth down the windpipe and into the lung airways (bronchi). The patient is given a local anaesthetic that numbs the mouth and throat to relieve discomfort while the bronchoscope examines the lower airways and collects sample of suspected tumour growth.
3. Needle Biopsy
Needle biopsy is useful in cases when the tumour sits on the lung periphery, where a bronchoscope cannot reach. A fine needle is inserted through the chest wall to directly reach the tumour and collect tissue sample for analysis. A CT scan or X-ray may be used to direct the needle.
4. Thoracoscopy
This procedure is conducted under general anaesthesia. Two to three small incisions are made to allow a tube to pass into the chest, using which the doctor looks for cancerous growths and takes samples. Overnight hospital stay may be needed to drain out any remaining fluids from the lungs.
5. Mediastinoscopy
This procedure allows a careful examination of the mediastinum or the centre of the chest. The doctor makes a small incision at the bottom of the patient's neck to pass a thin tube into the chest. Fitted with a camera, this tube allows the doctor to look inside the chest and draw samples of suspicious growths in the lung and lymph nodes. This test is conducted under general anaesthesia and the patient may require hospital stay for couple of days.
Staging The Cancer
An important step in the diagnostic process is determining the stage of cancer, i.e. the extent of spread. Knowing which stage the cancer is at is useful in deciding the right treatment. Various tests that help determine the cancer stage are MRI, CT scans, positron emission tomography (PET) and scanning of bone. Based on these tests, cancer in the lung is divided into the following stages:
• Stage I - Limited to lungs; smaller than two inches.
• Stage II - Grown more than two inches or is smaller but spread to chest wall, diaphragm or lung lining, or lymph nodes.
• Stage III - Large tumour and other nearby organs involved, or small tumour but spread far from lungs.
• Stage IV - Cancer spread to other lung too and distant organs.
It is important for patients to take worsening lung symptoms seriously and consult the doctor at the earliest for timely lung cancer treatment. Find the list of top cancer hospital in mumbai and book doctor appointment online.

Radiation Therapy-FAQ

Pre Treatment

1. 1. What is Radiation Therapy?

• • Radiation therapy is a common treatment for cancer that uses radiations like x-rays, gamma rays, protons or electron beams to destroy or control malignant cancer cells. The other names for it are radiotherapy, irradiation, x-ray therapy, or radiation oncology.

1. 2. How does it act?

• • Cancer cells multiply and divide faster than normal cells. Radiation therapy is a localized treatment, which works by breaking the internal part of the DNA cells of a particular area. In this way, the radiation stifles the growth and the division of the malignant cells and often destroys them completely. Only in a few rare cases the radiation is given in an entire vein or orally. In such treatment the radiation passes through the whole body to reach its target region. Sometimes the nearby normal cells are also affected by the radiation, so the treatment should be carried out under meticulous supervision.

1. 3. What are different types of Radiation therapy?

• • Radiation therapy can be broadly divided into two categories:

1.  External Radiotherapy
2.  Internal Radiotherapy
3.  External Radiotherapy: A patient undergoing external radiotherapy is given high energy radiation at the cancerous site by a machine, which is directed exactly to the treatable area. External radiotherapy is a course of treatment given over a span of few weeks. The treatment is painless and takes around 15 minutes. The external radiotherapy is of several types:

1. a. Three-Dimensional Conformal Radiation Therapy (3D-CRT) – It is used to show the shape, size, and location of the tumour through MR, CT, or PET scans. The radiation beams are modified according to the size of the tumour and then given from several directions.
2. b. Intensity Modulated Radiation Therapy (IMRT) – It is an advanced form of 3D-CRT, in which the beam’s intensity can be adjusted and the radiation is more properly shaped to fit the tumours size.
3. c. IGRT – It uses image guided radiation therapy, because there is a chance of the tumour moving between treatments.
4. d. Tomotherapy – In this, IMRT is combined with Computed Tomography scanning technology to create 3D images of the body’s interior.
5. e. SRS – In SRS, superior image-guided technique is used to deliver an exact dose of radiation to a small tumour in the head and neck region.
6. f. SBRT – In SBRT, the same technique as SRS is performed in the other parts such as the liver, lung, spine etc.
7. g. Proton Therapy – In this proton beams are used to treat cancer.

1. Internal Radiotherapy: In Internal radiotherapy, also called Brachytherapy, a radioactive source or a needle is placed inside the body of the patient. The radioactive source can be solid as well as liquid. If a liquid source is used, it is often termed as radionuclide therapy. In this type, the patient’s movements are often restricted until the radioactivity has fully disappeared from his/her body.

4. What is the dose of Radiation Therapy?

• • The dose depends on two things:

1.  Type of Cancer
2.  Stage of Cancer

The other factors considered by the radiation oncologist are:

1.  If the patient is under Chemotherapy
2.  If it is administered before or after the surgery
3.  What is the degree of success of the surgery
4. Generally, in curative cases the dose of radiation on a solid epithelial tumor varies between 60-80 Gray while on lymphomas the amount of radiation varies between 20 to 40 Gray.
5. The dose is actually a part of the treatment planning and the oncologist prescribes the dose in a way that the dose concentrates mainly on the tumor and affects the surrounding healthy tissues the least.

5. Who will plan & decide my Radiation Therapy?

• • A team of highly trained medical professionals work in unison to plan and decide the radiation therapy.

6. Who all are parts of Radiation Oncology Team?

• • The team includes:

1. Radiation oncologist: He/she will be in charge of the entire therapy and plays the chief role in developing the patient’s treatment plan.
2.  Radiation oncology nurse: He/she assists the radiation oncologist throughout the therapy, monitors the patient’s health 24*7 during treatment, gives valuable suggestions regarding how to control probable side effects and also offers support to you and your family.
3.  Medical radiation physicist: He/she has a thorough knowledge of the radiation equipment and often helps the oncologist with complex treatment plans.
4.  Dosimetrist: He/she is a person, who works with the medical radiation physicist and the oncologist to develop the complex treatment plans and prescribe the apt dose of radiation.
5.  Radiation therapist: Also called radiation therapy technologist, his/her primary responsibility is to maintain the treatment machines and administer the scheduled treatments.
6.  Other medical and health care professionals: Other professionals include general physicians, nutritionists, dentists, counsellors, physical therapists, and social workers.

1. 7. What are the benefits of Radiation Therapy?

• • There are many benefits of Radiation Therapy:

1.  It can destroy cancer cells of almost all parts of the body. It not only treats cancer but also successfully eliminates the tumor in some cases to prevent recurrence.
2.  It shrinks the tumor before surgery and treats remaining cancer cells (if any) after surgery.
3. Palliative radiation therapy (when the complete elimination of the tumor is not possible) increases life span, reduces pain and lessens other cancer symptoms considerably.
4.  It improves the overall results of treatments such as chemotherapy or other hormonal therapies if given simultaneously.
5.  According to most patients, the effect of this therapy is minimal on daily schedules.The patient needs not stay in the hospital during the course of the radiation therapy in most cases and the sessions are carried out on an outpatient basis.

1. 8. What are the side effects of Radiation Therapy?

• • The side effects of radiation therapy might crop up within a few days or weeks of the treatment or might not show up still months. The side effects depend a lot on the area where the therapy is given. However there are some common side effects that are found in many patients:

1.  Fatigue: The radiations while destroying the cancer cells often give rise to substances that lead to fatigue. Besides, fatigue is also caused by lower blood count, anaemia, malnutrition, pain, steroids, chemotherapy, some high dose drugs and depression. There is no specific treatment for fatigue. If it is caused due to lower blood count, blood transfusion might help. Moderate exercises and a happy and healthy lifestyle also lessen fatigue to a great extent.
2.  Skin changes: The latest procedures of radiation therapy cause less skin damage but still a faint redness is generally noticed on the patient’s skin after the treatment. The skin gets overtly sensitive with some blistering of the outer layer. The skin may also get dry and itchy and the pigment may turn darker. The skin becomes thin gradually in some cases and sometimes wounds on the treated area take a lot of time to heal. Application of aloe vera, lanolin or Vitamin E helps but this should be done under proper supervision of the doctor. The patients can also use a hat and scurf while going outdoors. This will prevent the skin problems from getting aggravated.
3.  Throat and mouth problems:Mucositis or inflammation inside the mouth and throat is another side effect of radiation therapy. It is a short term side effect and gets better with time. Mucositis makes swallowing difficult and patients tend to lose weight as they cannot eat properly. Other mouth problems include dry mouth, damaged salivary glands, thick saliva etc. The patients should always keep their mouth cleanduring the course of the therapy and also when it’s over. If the situation turns too critical and eating becomes really difficult, a feeding tube is connected with the patient’s stomach for enough supply of nutrition. Radiation often affects the teeth and a proper mouth care post therapy is extremely necessary. Patients should consult a dentist before going for the surgery, who can suggest precautionary measures beforehand.

9. What is the cost of Radiation Therapy?

• • The cost of the Radiation therapy varies from one oncology centre to another. If advanced equipment are used, the cost is likely to go up. The cost also depends on the number of scans required for the patient. Most health insurance plans cover it; however sometimes the patients need to pay for a few processes of the treatment. It is always better to have a clear discussion with the hospital office regarding their policy and how the health plan can be implemented before starting the treatment. Unfortunately, the cost of Radiation is drastically going up currently making it difficult for patients belonging to a lower income group.

1. 10. How are different types of Radiation Therapy given?

• • In the external radiotherapy the doctor first specifies the area that is to be treated. This comes under a process called simulation in which the radiation therapist uses a CT scan or an MRI machine to define the treatment field (or port). Radiation beams are aimed very specifically on the marked region. When the radiation is given, a leg mold or mask is used to keep the patient static in one position. The mark should not be removed as it is required until the treatment is over.

In case of internal radiation therapy, an implant is placed inside the tumor of the patient’s body. It is positioned in a way that it affects the normal cells as less as possible. In this type of surgery a higher dose of radiation is given to a smaller area, which is always not possible in external radiation therapy. In brachytherapy (the biological name for internal radiation therapy) two methods of radiation therapy are used:

1.  Intracavitary radiation: The implant is placed in a specific cavity of the body like rectum or uterus.
2. 
   
3.  Interstitial radiation: The implant is placed in the tumor itself or very close to the tumor. This type shows early results and is more commonly used.
4. Different kinds of implants are used in internal radiation therapy that include seeds, balloons, tubes, pellets, wires, needles, or capsules.

1. 11. Do I need to get admitted for Radiation Therapy?

• • The patient undergoing external radiation therapy needs not stay in the hospital. It is generally given during outpatient visits. It also does not take much time; 15-30 minutes is enough for a session of external radiation therapy.

For internal radiation therapy the patient often stands a chance of emitting radioactivity which is detrimental to other people. So, he/she needs to stay in the hospital for a few days during the treatment till all the radioactive sources have completely disappeared.

12. How much time is required for Radiation Therapy?

• • It takes very little time. It requires 15 minutes to 30 minutes. Only in a few special cases it takes more than 30 minutes. A full course of treatment requires several weeks in some cases and in some other cases the treatment gets over just within a few days.

1. 13. What steps will I have to follow to get Radiation Therapy?

• • It follows a number of steps.

1. First, the patient needs to have a consultation session with the radiation oncologist and his/her medical team. During this visit the doctor does a thorough physical examination of the patient, scrutinizes his/her medical history and discusses the feasible treatment options. After this session the doctor either gives a date on which the therapy will start or he/she may ask the patient to come for a follow up visit. The consultation session takes around 2 hours.
2. In maximum cases the consultation session is followed by a simulation appointment. The main purpose of the session is to map the exact area, where the radiation beams will be directed. Once the area is figured out, a CT scan is performed to verify the anatomical features of that particular area for assurance. If the scan report comes as expected, the area is dotted with permanent ink, which is not removed till the treatment is over. The radiation therapist will have a clear cut discussion with the patient regarding his/her treatment time and how many sessions he/she requires. The simulation appointment takes around 1 hour.
3. The radiation therapist generally schedules a date after two or three weeks of the simulation session. This is the time when the radiation oncologist create a proper treatment plan taking into account the patient’s physical condition, the present state of his/her tumor and his/her medical history. On the basis of these, the oncologist decides the type of radiation equipment that will be used for the surgery as well as the amount of radiation needed.
4. Once the plan is properly chalked out the radiation treatment starts. The treatment procedures vary from one cancer type to another and from one individual to another as well. Even a single patient might find a difference between his/her previous session and current session.

1. 14. How can I choose Radiation Therapy Machine for myself?

15. My Radiation Therapy is over. How should I follow up with my doctor now?

• • Once the entire course of treatment is completed, the radiation oncologist schedules some follow up visits. He/she needs to examine you at intervals to see if any side effects are cropping up and how those can be taken care of. Besides, he/she will give the patient a set instructions, that need to be strictly followed.

GERD (Gastroesophageal reflux disease)

1. What is GERD?

• GERD is a chronic digestive disorder in which the lower oesophegal sphincter (LES) is affected. LES is the ring of muscle between the oesophagus and stomach. GERD typically occurs when the contents and acids of the stomach flow back into the oesophagus causing irritation in its inner lining. The full form of GERD is Gastroesophageal reflux disease. People may suffer from GERD due to hiatal hernia. GERD may cause heartburn or acid indigestion in pregnant women. Change of diet and lifestyle helps to cure this condition; however in critical cases, patients need medication or even surgery.

2. What are the symptoms of GERD?

• All the symptoms of GERD are more or less related to the digestive system.

• The most common symptoms of GERD are heartburn, nausea and regurgitation (ejection of food materials from the pharynx or oesophagus due to the presence of undigested food materials). Heartburn usually refers to a burning sensation that occurs in the chest, especially at the centre. The pain may shift towards the abdomen or the neck or back. Such a pain occurs mostly after meals.

There are other GERD symptoms as well.

• The acid reflux often passes through the upper oesophageal sphincter and reaches the throat or voice box causing sore throat.
• GERD causes coughing very often at night but the link between the two is yet to be proven.
• Laryngitis is another common symptom of GERD.
• GERD may worsen asthma by causing irritation in the airways. On the other hand GERD itself gets worsened as a result of asthma medications.
• There are some minor symptoms of GERD that include lump in the throat, sudden increase of saliva, pain in the ears, a constant feeling of discomfort in the chest, etc.
• Among children, the symptoms of GERD show in the form of repeated vomiting, unexplained coughing, difficulty in breathing, etc. 

 3. Whom should I contact in case I have GERD symptoms?

• If a person is suspected to have GERD he is generally referred to a gastroenterologist (a doctor who specializes in digestive diseases).  

4. Is my case mild, moderate, or severe?

• If the disease is in its mild stage it is hard to detect. The damage has already started in the oesophageal sphincter but the patient does not feel it. The severity of Gastroesophageal reflux disease is determined by the intensity of the heartburn, which depends primarily on its frequency and duration. Besides, the presence of regurgitation also assesses if the GERD is mild, moderate or severe.

5. Medications I am currently taking are causing me GERD symptoms?

• Gastroesophageal reflux disease is often aggravated by certain medications.

• Medicines that are responsible for relaxing the LES, thereby inducing or increasing acid reflux are:
• Anti cholinergic medications (taken for nausea) that include promethazine (Phenergan), prochlorperazine (Compazine) etc.
• Antidepressants that include doxepin (Sinequan), imipramine (Tofranil) and amitriptyline (Elavil)
• Medicines taken for asthma that include bronchodilators like theophylline (Uniphyl) or beta-adrenergic agonists
• Sedatives or tranquilizer like temazepam (Restoril), diazepam (Valium) etc. and also medications that contain oestrogen.
• Medicines that directly cause inflammation in the oesophagus are:
• Osteoporosis medicines (Bisphosphonates) like alendronate (Fosamax)
• Iron tablets
• Potassium supplements
• Quinidine, a medication prescribed for heart diseases

   There are some other medications that may worsen GERD.

• Medications prescribed for blood pressure that include beta blockers or calcium channel blockers. Some of the examples are diltiazem (Cartia, Cardezem), verapamil (Calan, Isoptin), nadolol (Corgard), and nifedipine (Adalat, Procardia).
• Narcotics like oxycontin and morphine
• A three year study conducted on the role of non-steroidal anti-inflammatory (NSAID) drugs in aggravating GERD shows that people who take NSAIDs like aspirin, naproxen (Aleve) and ibuprofen (Motrin, Advil) for months or years are likelier to suffer from GERD symptoms than those who don’t take such medications.

6. If I have chest pain, how can I differentiate whether it's GERD or a heart problem?

• Heart burn has no connection with the heart directly or indirectly. The pain occurs in the middle of the chest because the heart and the oesophagus are located very close to each other. However, many people mistake heart burn for angina (a heart disorder that may lead to a heart attack) and sometimes vice versa. An easy way to differentiate between the two is if the symptoms go away as a result of belching, it is heartburn. But if sweating or breathing difficulty occurs due to shortage of oxygen, the chest pain is likely to have arisen due to heart related problems. The most accurate way to determine is to consult a doctor because symptoms might differ from one individual to another.

7. Which foods or beverages I should avoid in case of GERD?

• Mild and moderate cases of Gastroesophageal reflux disease get cured considerably just by changing diet and lifestyle. So getting a good diet should be a matter of prime importance for GERD patients. The doctor generally gives a proper diet chart to patients. The best way to follow a diet is to maintain a food journal. The main cause of GERD is malfunctioning of the LES. There are foods that intensify malfunctioning whereas some others minimize it.

According to experts, the foods that can directly or indirectly cause GERD symptoms are:

 High-fat foods: French fries, onion rings, cream sauces, creamy salad, dairy products (butter, regular cheese, milk etc.), fats of lamb, pork, or beef, bacon, lard, ham and high calorie snacks and desserts (chips, ice cream etc.)

 Tomatoes and tomato products like tomato sauce, salsa sauce etc.

 Citrus fruits like lemons, oranges, lime and grapes

 Chocolates (It contains methyxanthine, which relaxes LES muscles)

 Garlic and raw onions

There are no such foods that can prevent GERD from appearing but some foods can lessen the symptoms of GERD.

 Probiotic Yogurt

Probiotic yogurt or other foods that contain probiotics help in digestion. Probiotics help in treating digestive problems like constipation, diarrhoea, abnormal bowel syndrome etc. The reason probiotics have this effect is undetermined but studies have shown these microorganisms to be beneficial in reducing the adverse effects of GERD.

 Peanut Butter
Peanut Butter has lower fat protein and is helpful in reducing GERD symptoms. However, everyone doesn’t have equal tolerance to peanut consumption and some patients are allergic to it.

Fibre
According to a leading international journal in gastroenterology, “Gut”, people whose diet consists of more high fibre foods are 20 percent less likely to have GERD. 

8. Are there any lifestyle changes that might help relieve my symptoms?

• Lifestyle changes relieve GERD symptoms to a great extent. Eating healthy food is the primary thing that should be done to reduce GERD symptoms. Other lifestyle changes must include:

 Limiting the intake of caffeine and alcohol

 Quitting smoking

 Exercising regularly (Weight gain aggravates GERD)

 Practising meditation, yoga or other stress reduction techniques

 Losing extra weight

 9. Should I take medication? If so, do I need a prescription?

• If it is a moderate case of GERD medicines either prescribed or non-prescribed can prevent complications. However, it is wiser to visit a doctor and take medications prescribed by him/her.

The medications for GERD generally include:

 Antacids: Some antacids like Mylanta and Tums neutralize stomach acid relieving heartburn though temporarily.

 H2 Blockers: There are prescribed as well as non-prescribed H2 blockers. If non-prescribed H2 blockers are unable to relieve pain, the ones with prescribed strength help. Common H2 blockers include famotidine (Pepcid) and cimetidine (Tagamet). These help to decrease the acids in the stomach.

 Proton pump inhibitors: These also help lessen the acids in the stomach. Some of the proton pump inhibitors can be available without a prescription. Some common proton pump inhibitors include omeprazole (Prilosec) and lansoprazole (Prevacid).

These medicines play a major role in decreasing the acid content of the stomach, but patients can still suffer from heartburn sometimes. Along with taking medicines, they should maintain proper food habits and a healthy lifestyle to get the best results.

10. What should I do if the medication doesn't seem to help?

• If medication doesn’t help, the patient has to undergo a surgery. Besides, there are other alternative processes of surgery that may be explored. These processes include magnet therapy, acupuncture etc.

Nissen fundoplication is the most common surgical procedure for GERD. The surgery is done to prevent stomach acids from entering the oesophagus. It is the most effective procedure till date but has some side effects as well that include trouble in swallowing, gas formation or bloating, flatulence (gas formation in alimentary canal) etc.

11. Will I need any tests or examinations?

• If the symptoms of acid reflux disease are chronic heartburn or regurgitation, it is easier for the doctor to diagnose. However there are other symptoms which are less direct. These include anaemia, weight loss, difficulty in swallowing, etc. and in case of these symptoms, doctors usually prescribe the following tests:

 Barium Swallow Radiograph: It is a painless test in which the patient has to swallow a solution of barium, which enables the doctor to take an X-ray of his/her oesophagus to examine if there is any anatomical problem in the oesophagus. However, it is not the ultimate test to detect GERD. In fact the X-ray can detect oesophageal changes on only one out of three people with GERD.

 Endoscopy: An endoscope (a small tube with a fiberoptic camera) is inserted through the mouth into the oesophagus to check for irritation in the inner lining of the oesophagus. The patient is given local anesthaesia or a mild sedative before carrying out the test. It is a painless test that takes less than 20 minutes to detect GERD complications including Barrett’s oesophagus. However, not all GERD patients have irritation in the inner lining of the oesophagus. 

Website - http://www.credihealth.com/doctors/mumbai-region/gynaecologists

FAQs – PICC line

1.       What is PICC line?

·         A Peripherally Inserted Central Catheter line is known as PICC line. It is a flexible plastic tube that can be attached to a syringe or a drip that contains your medication. This line is used to give treatments like chemotherapy, antibiotics, blood transfusion, liquid fluid, and IV (intravenous) fluids. It can also be used for different treatments at once by dividing it into 2 – 3 lines. The patient can even go home with it and it can be left in for several months. This line is inserted by a doctor or a specialized nurse.

2.       What are different types of PICC lines?

·         There are two types of PICC lines:

a.       Groshong – The Groshong PICC line self seals itself and does not require a clamp. It has a slit in the side at the internal end, which opens only when blood is being drawn or when fluid is being inserted.

b.      Open-Ended – The Open-Ended PICC line does not have a slit in the end and always stays open. It needs to be closed by a clamp when not in use, so that the blood does not flow back into the line. 

3.       What are the benefits of getting the PICC line inserted?

·         There are a lot of benefits of getting a PICC line inserted:

a.       Versatility: These lines are very versatile and can be used to administer anti-cancer drugs, antibiotics, intravenous fluids, blood, and nutrients. They can be kept in the body for a long time and are essential for treating cancer patients, as well as patients who need medications for a long time.

b.      Low risk of infection: There is a very low risk of infection, as the insertion of the line is done through sterile techniques. The area is also covered with a dressing keeping it clean and dry, which reduces the risk of infection.

c.       Early discharge: The patient can be discharged early, as he/she can go home with the line inserted.

d.      Decreased skin puncture: These lines can be used to draw blood samples for various diseases, thus the patient does not need to take injections for everything. This relieves them of the repeated pain, puncture marks, and risk of infection.

4.       What are the risks of getting it inserted?

·         Along with all the benefits, there are a lot of risks related to the line:

a.       Infection: There is a possibility of an infection developing in the tube or in the area around the line. The patient should contact the hospital or a doctor if –

                                                                                 i.            There is redness, pain and swelling in the area.

                                                                               ii.            He/she experiences muscle aches, fatigue, weakness, chills, or fever.

                                                                              iii.            Discoloured fluid is discharged from the site.

                                                                             iv.            Blood pressure decreases

                                                                               v.            The white blood cells count goes up

b.      Air in the line: There is a chance of an air bubble getting in the line, which then enters the blood stream. This may result in the patient experiencing light-headedness, shortness of breath, chest pain etc. Extra care should be taken to put a clamp or a cap at the end of the line when it is not being used.

c.       Blood Clots: A blood clot may form in the vein at the end of the line. This can be treated with medication but the catheter might be removed.

d.      Line may come out: The line may come out by accident if the dressing is not secure. In this case it needs to be replaced immediately.

e.      Line may break: There is a chance of the line getting cut or splitting, though it is not very common. In this case, the patient needs to contact the hospital immediately and get it removed.

f.        Phlebitis: Inflation in the vein where the line is inserted.

g.       Nerve Injury: At the time of inserting the line, the nearby nerves might get injured.

h.      Leakage: Leakage can happen at the sight of insertion due to rupture or migration of the line.

5.       What is the cost of PICC line?

·         The cost of PICC line in India ranges from Rs. 1400 to Rs. 4200 (according to the figures of 2008).

6.       Can I move my arm after getting PICC line inserted?

·         The patient should move his/her arm as normally as possible after getting the line inserted. If there is a slight pain, then a warm compress can be applied to the area. The patient should take certain precautions while they have the line inserted in their arm.

a.       The patient should not swing the arm vigorously.

b.      Extra care should be taken while changing clothes.

c.       Swimming or any other water activity is prohibited.

d.      Strenuous activities that lead to perspiration should be avoided.

e.      Refrain from lifting heavy objects.

7.       How is it inserted?

·         After the cleaning the area with an antiseptic solution, local anaesthesia is given to the patient. When the area becomes numb, a needle is inserted in the vein through which the PICC line is threaded. This line is a soft, long, and flexible plastic tube, which is inserted in a large vein in the arm near the elbow like the basilic vein, cephalic vein, or brachial vein. It is then guided up the vein towards the heart, till the line reaches the cavoatrial junction or distal superior vena cava. It is then held in place with the help of a transparent dressing. A chest X-Ray is done to see if the end of the line is correctly positioned.

8.       How is it removed?

·         Removal of the catheter is easy and painless. Usually a trained nurse pulls it out gently, and it just takes a few minutes. This process can even be done at the patient’s home. Sometimes, there is a possibility of resistance due to a venous spasm (sudden contraction of a vessel wall). When this happens, it takes more time to remove it. The line should never be pulled out forcefully, as there is a chance of it breaking. After it is removed, the area is bandaged with a sterile gauge. The wound is to be kept dry for a few days so that it can heal.

9.       How should I take care of it?

·         When the patient is in the hospital,the nurses take care of the PICC line. They check for leakage, inspect the dressing, and flush the catheter. But when the patient is not in hospital, either a nurse has to do the checking or the patient’s relatives and family members can be taught how to take care of it. They can take care of the line in the following manner:

a.       It has to be flushed at least two times a day, after every 12 hours, when it is being used. This is done by flushing 0.9% saline with a syringe to prevent the line from clotting.

b.      When the line is not in use, it can be flushed once a week to prevent it from getting blocked.

c.       The dressing keeps the site clean and holds the line in place, so it should be changed every week. If the dressing becomes loose, then it needs to be changed immediately. A clean dressing prevents infection.

d.      The bungs or caps also need to be changed every week along with the dressing and the clamp should be closed when the line is not in use.

e.      Scissors are not supposed to be used, as there is a risk of the line getting cut.

f.        The line should be kept dry while taking a bath. The dressing can be covered in waterproof covers or plastic bags to prevent from getting wet.

g.       Avoid checking blood pressure in the arm having the line.

10.   What all precautions should I take?

·         The precautions to be taken are:

a.       The dressing or the line should not be pulled.

b.      Avoid touching the PICC area.

c.       The patient should not swing the arm with the line vigorously, and extra care should be taken while wearing or removing clothes.

d.      Hand should be properly washed before taking care of the area.

e.      The PICC area should be properly covered at all times, even while sleeping.

f.        The dressing should always be kept dry and clean, and all the edges of the dressing should be completely sealed.

g.       If the line does not get flushed easily, do not force it and immediately contact your doctor.

h.      Keep scissors and other sharp objects away from the PICC line so that it does not get cut.

i.         Use sterile equipment, and clean the cap before and after every use.

11.   After how long I should get it removed?

·         The line can be kept in the arm for weeks or months. The patient can get it removed when it is no longer required. You should also discontinue it after consulting your doctor, when an infection occurs or the line gets blocked or damaged.