today on the transplant hook we're gonna be discussing the differences between a
swan-ganz a port a central line and a PICC line these four things are often
used in the around time transplant and so because of that I believe knowledge is
power so the more we can know about these
devices what their uses are how they're implanted the better off we are so if
that interests you in any way how about go ahead and stay tuned
hey folks welcome to the transplant helper today my name is Jim Murrell today we're going
to be answering a viewers question of sorts and that is basically Jim what are
the differences between a swan-ganz a port a central line and a PICC line I
thought it was a very good question it's one that I received on numerous
occasions matter of fact it's one that I saw just
the other day on one of the Facebook groups I'm a member of and I thought it
was a very good question now if you're a believer like I am that knowledge is
power that the more we can educate ourselves the better off we'll be then
today's program is just for you so let me go ahead and encourage you before we
begin our discussion today if you've not already subscribe to this channel right
now would be the perfect time to do that go ahead and click the subscribe button
right beneath the program as well as maybe even the bail notification off to
the right of that and that will allow you to receive these programs will be
notified as soon as they come out each and every time I like to publish on
Tuesdays and Thursdays but I throw in a few episodes for bonus as we go so I
hope that you'll do that this program is all about advocating educating and
motivating you as a transplant patient and helping you to do the same so
without any further ado let's jump right in let's start with the most invasive of
these procedures and move toward the bottom as we go through number one what
is a swan-ganz now that's kind of a strange name to have for any kind of
medical device or implanting device but I did want to answer it anyway and the
swan-ganz is basically also known as a pulmonary artery Catherine here right in
that that it's placed in the pulmonary artery generally it's placed right in
the right side of your neck I'll be it if the doctors have to they can take a
little longer route and come through the left but nonetheless the right side of
the neck the swan-ganz is almost always placed in a surgical area that is a
surgery room because it has to be done in a completely sterile environment
generally speaking when a swan-ganz is implanted in the body you're sedated
heavily or maybe even knocked all the way out if you will like you would for
any other surgery and they do that obviously so not only you don't remember
the procedure but you don't feel any pain while it's going in and it's kind
of complicated to place and so the doctors really have to take
their time and they really don't need you moving around or as I would be
probably asking questions while they're going through this now this is also
known the swan-ganz can also be known as a perpetual catheter by perpetual that
just simply means an ongoing continual catheter or in this case a cath and
that's much what this is all about it's just about like doing a heart cath which
you'd be done through your groin sometimes through your neck sometimes
through your wrist and in other areas they can do hard cans and cath labs this
is usually much the same way I'll bet this is implanted over a period of time
so that you can keep it over a number of weeks and you can use it while you're in
the hospital and generally speaking once it's placed you're sent back to your
room the monitors the the machines are hooked up and they continually monitor
pressures in the heart and or lungs but particularly and mainly in the heart now
these pressures are extremely important just like the ones that are done in the
cath lab to let the doctors know some major and important information about
you one would be your ejection fraction one will be the oxygen and output and
input coming in and out of your heart another would be just general heart
pressures as a matter of fact the swan-ganz one of the lumens that comes
out of it and they're about for them a thing but one of the lumens or tubes
that comes out of the swan-ganz generally speaking has on one end of it
on the inside at least a little tiny balloon and on the other end they
usually just willy would raise the pressure or expand that balloon by
pushing a syringe on the outside of it now what that does during that and this
is one of the major uses for it what that does is they'll generally have that
place there in that artery they'll push the balloon and and block off a portion
or a part of aim whatever it is going in or out of your heart and by blocking it
off they can then sense how hard your heart is willing to pump or press
against that hence heart pressures are measured again it's so much like an
actual heart cath or a catheterization done inside of a cath lab albeit this is
you so you can stay in your hospital room you're typically bedridden with
this but nonetheless by the end you're probably so sick you you don't mind but
you're in your room you're pretty much flat of your back
let you move a little bit but the swan-ganz is placed and it gives them
constant measurements of pressures oxygen levels a cardiac output ejection
fraction all that stuff so swan-ganz is the most invasive and it's used for just
that purpose that is being a type of calf now in the next place or I should
say in the next three places the port the central line the PICC line are often
used for exactly the same thing and that is for the introduction of medications
into your body in a very direct way there really not a whole lot different
than your average IV line you might get in your hand or your elbow your wrist
whatever but they do it in a much more permanent way so let's start with the
next invasive of these and that is the port oftentimes referred to as a central
venous catheter it is basically placed under the skin and that is usually done
also like lips one is usually done the ports are placed inside of a surgical
area and that is again it has to be extremely sterilized they have to be
very careful they generally sedate you for this also
for the same reason so you don't know and remember you don't have knowledge of
it and so you do not feel the pain now while you're sedated for this you may
not be completely knocked out but you'll be so heavily sedated your mouth can
probably go to sleep and you certainly won't remember anything when I place
this generally speaking when it's done with the port is it's a little device
it's a little drum they call it about the size of a quarter maybe a little bit
smaller but it's placed somewhere in generally the right side of your chest
right here on the on the breast if you will place beneath the skin but on top
of the muscle generally after it's placed you can feel the little drum you
can rub it you can feel it you can kind of squeeze and detect where it is
because connected to that drum is a catheter of sorts that goes up
underneath the skin turns back down and also goes in a central venous or that
permanent artery if you will it basically again delivers medication into
your body and gives it to you in a quick way much faster than in general IV might
be in your hand or arm it delivers medication or spills medicine directly
into the heart therefore it is pumped throughout the body very quickly but
it's used for more peculiar purpose now the reason a
port might be placed is because the doctors have determined that you need
some type of intravenous type medicine over a long period of time and typically
ports are put in not only in transplant patients but more likely more commonly
say for example in cancer patients or save someone who's suffering with Lyme
disease or some chronic disease that's going to go on and need to be treated
for a long period of time ports can last up to ten years and they're easily
accessible I'll be it they're not on the top of the skin or underneath the skin
here's the beauty of that their excess through a needle so basically you or
typically a home health nurse whomever someone at the clinic or hospital would
access that with a needle again going into the drum basically plugging in if
you will to deliver medication it may only go in for an hour two or three and
then they pull the needle out place a band-aid over it and within an hour so
you can be back home doing whatever you want to do when you feel like it or if
you do but you can be back moving about even taking a shower and that's gonna be
divided between this one and the next or the last two that we discussed and that
is where the port the convenience says it's accessed with a needle when the
needles pulled out you're totally clear to go ahead and shower go back to
activity exercise whatever it is you need to do the port and one in itself
because it's underneath the skin and the skin protects it is probably the best
one for long-term use hence why it's used for cancer patients transplant
patients and many other to deliver long-term medicine now the next one
beneath that not a port but a central line is a little bit different now a
central line can be done for the same reasons that is the delivery of
medications that are quick fast and in a hurry way but central lines are often
placed either in the neck it looked a lot like the swan-ganz when its place
I'll bet it usually only has two or maybe three lumens that come out of it
or ports but it is placed usually in the neck running the same path if you will
right down in the body through heavier veins and it is sent meant for the
delivery of medications but it can also be placed much like the poor
in the chest area pretty much in the same area stuck there through the skin
and then going up and dropping in the difference being that between a port and
a catheter or if you will this central line is that you had the lumen sticking
out so you got little fingers a little line sticking out that can be basically
tapped on to like a PICC line we're about to talk about or like a general IV
now the difference between that is basically with a central line whether
it's in your neck or whether it comes out your chest or wherever they choose
to have it pop out that one cannot be allowed to get wet so if you're going to
take baths or showers you're going to have to completely cover that take care
of it and really just do the best you can and again it cannot get wet both of
these things the central line as well as the next one coming up the PICC have to
be cared for by a home health nurse and we'll say more about that in just a
moment but it's central access central venous access is what a central line is
now in the last place the least invasive but for me it was a lifesaver at the
time there's what's known as a PICC line and Picht stands for a peripherally
inserted central catheter by peripherally it just means basically in
the arm generally PICC lines are going to come
through the arm again very similar to the central lines very similar to the
ports the uses are same but it's placed inside the arm now the beauty of a PICC
line on the one hand is that although it's done in a sterile environment it's
generally done right in your hospital room right in your doctor's office right
in clinic wherever you are you don't have to go into surgery for that and
generally you're not giving any consultation other than maybe just
something for your nerves as they dead in the area with lidocaine
and then insert it up through your arm that goes pretty much the same path goes
up through a major vein there are three to choose from up here in the top of the
arm goes in goes around and drops off into your heart now the downside of this
one if there's a downside is again you're not able to shower you're not
able to actually wash the area per se as far as showering mads you've got to keep
it covered and it has to be cared for on a very regular basis generally speaking
that's done by a home health nurse who comes out to your house or wherever
you are but comes in changes the dressing being very careful to keep it
sterile and clean covers it back bandages it up and again you kind of
like that central line coming from your chest
you've got lumens hanging out of your arm that can easily get snagged pulled
whatever and if the PICC line gets pulled to any extent and pull too far
out of the heart gets back up into the vessel the vein there it can cause some
bad agitation from the medications going in so it would have to be replaced
pulled out a new one put in you go through the procedure all over again the
downside being you can't shower the downside being you have to keep it
cleaned and all that versus a port but nonetheless it is used for shorter term
use as I said a moment ago the port can be used for up to 10 years PICC lines
are generally supposed to be used under a year most people would like how long
average I guess they probably have PICC lines for three four or five months
something happens you know get a little infection whatever even if it's just
kind of right on the skin whatever but they have to be replaced PICC lines are
great though I wore a PICC line for ten months
fairly successfully I had an IV bag tied to it 24/7 but it allowed me to go home
and go on about my life so it was a wonderful thing really to have in the
long run so basically backing up and recapping a swan-ganz is a continual or
perpetual cath going on actually heart cath for function and for lung function
a port is a very good option for long-term use right on the skin the
little drum is placed it only has to be accessed by a needle and when the
needles pulled out you're going about your life a central line goes in through
the neck can come out the chest in the similar way but has the lumens coming
out and therefore it has to be cleaned washed showers are not to be done but it
delivers some medications quickly and a PICC line the final one was the one that
goes in your arm it hangs from your arm all the similar problems of the central
line except for the fact it's definitely convenient I know it's one that you can
mostly manage for yourself as far as swapping bags keeping IV pumps running
all of that it's a good home remedy to be used about a year or less if they can
if not you keep going it's all good
nonetheless I hope this has helped to explain these four things in in some way
to you help to describe them again I say again knowledge is power
education is knowledge and so that's what I'm trying to do here on the
program the transplant helper and I hope that you've already chosen subscribe if
not go ahead and do that now then give me a like or a thumbs up share this
program out to someone who it may help because even outside the transplant
world so many people are going to have to deal with these types of things and I
think the information would also help them out anyway until next time stay
stronger friends
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