Having a midline placed

I was fortunate to have a portacath (an implantable device that allows for long-term access to a vein) for seven years, through my most unwell years which was just fantastic because it saved me the pain of excessive needles and procedures when I was inevitably admitted to hospital. But since that had its dramatic departure last year, we’ve needed to find new ways of accessing my veins for IV antibiotics, infusions, taking bloods.

When I say “IV”, I mean “intravenous” meaning through the veins, it’s a far more effective method of getting medication into the body for more extreme cases of infection, but it does of course come with its own cons. Now, as expected, these antibiotics need to find a way into the veins in order to be used in the first place. As I mentioned above, these were administered through my port but now that has gone, we need to find alternatives. 

There are numerous forms of access, more commonly known as vascular access; midline, PICC (peripherally inserted central catheter), both of which are thin flexible tubes that go into the skin and into blood vessels, both of which can be used in the arms. There are other more invasive forms such as the Hickman Line which tend to be used in the neck. The choice of IV access varies based on the clinical purpose and the anticipated duration of treatment.

Before the port was placed in paediatrics, I was having midlines every three months which I can hardly remember because I was sedated to the moon for when they were being placed; I remember the pain but not the process. As result, although it wasn’t nice, it didn’t border into “traumatic” as such. We opted for the port in 2015 because my veins became so bludgeoned from lines, cannulas, blood tests etc, they just couldn’t take any more hits. Life was lovely with the port, whenever I needed IVs, a one-inch needle straight into the port in my chest and we were good to go. HOWEVER, the port rather unceremoniously left last year and as a result, I have had to reaccustom myself to midlines.

If you heard anything about the ordeal with my portacath removal last year, it won’t come as a shock to you that I am completely and utterly traumatised by any procedure involving needles, scapples, lying down and having people fussing around me. Even having gone through EMDR therapy to target the surgery, being in a situation where I’m helpless and vulnerable swallows me straight back on to that operating table.

A midline is an 8-12cm catheter that is inserted into a vein in the upper arm between the bicep and tricep, guided by the use of ultrasound. This is performed as a sterile procedure where the nurse is completely gowned up, there’s a protective sheet of paper draped over the site, it’s all very formal. The set up alone sends me into a bit of a spiral.

I’m not entirely sure of the placement process because A) I can’t see what’s happening and B) I’m doing my absolute best to be somewhere miles away in my mind. However, from what I can tell from the many times I’ve undergone the procedure, they anaesthetise the upper arm then go in with a wire / rod of some sort to push up the blood vessel in order to place the catheter. So, although the skin site is numbed, the feeling of this rod being shoved up your arm is not so subtle.

As with everything, my body has to make things difficult, because of my previous experiences such as the port fiasco, my body instantly switches into fight or flight where my veins shrivel and clamp up, essentially making whatever needs to happen to them very difficult indeed. Last year, it took four attempts to place the midline with two different nurses. This admission, it took three attempts, even with the use of sedation because my body simply will not let anything “harmful” happen to it #thebodykeepsthescore

Now, I knew this would be the case, so I requested to the doctor on duty to have some sedation and he simply replied “no, I don’t want to go down that road” (that road being a benzodiazepine addict) and “distraction worked well for the cannula” (cannulation taking two minutes, a midline at least half an hour). Another notch on my totem pole of Not. Being. Listened. To.

Eventually the nurse rolled in with her ultrasound machine and I burst into hysterical tears because I knew what she had come for. She was so reassuring; we agreed that she could look at my veins under the ultrasound just to make a judgement of how accessible they might be. There weren’t very good at all, so she stormed off to demand the doctor to prescribe Lorazepam, which I’m pleased to report that he did.

The procedure was all very painful and upsetting because the sedation started to wear off on the third attempt so the crying and hyperventilating ensued. I will say that the nurse was bloody excellent; she was so kind and so compassionate and patient with me and also did a very good job at getting one of my friends (who by happenstance was visiting at the same time) involved in the process to keep me calm and distracted (and a hand to crush when things got unbearable).

Anyway, the midline eventually was placed successfully, and the nurse and I had a bit of an emotional moment together. I can’t quite describe how comforting it is to have an empathetic member of staff to be supporting you through these things, it doesn’t make the pain any less but having someone there who is almost “suffering” with you, just makes you feel seen, heard and cared for.

The line should hopefully last me until the end of the admission (usually two weeks). The line is quite buried the arm so you don’t feel it in quite the same way as a cannula, but I can feel the medication run through in my veins it if it’s cold and sometimes it “spits” in my shoulder a little bit when the first flush goes in. I’m also quite sensitive to the dressings so I get this overwhelming urge to scratch at the area which is a big no no.

Overall, it’s all fine, just here getting topped up really before the winter hits and to get an iron infusion because I’ve been so tired and fatigued, everyone keeps commenting on how “pale and tired” I look, my hair’s shedding like crazy and my skin’s playing up again which is SO upsetting. C’est la vie, it’s nothing I haven’t done before.

(Just for the record, I know I've made a big old fuss about how terrible this procedure is, but the impression I've got is that it's nowhere near as bad for others as it is for me purely down to my body's hatred of medical procedures)