STORIES FROM THE FRONTLINE: AN INTERVIEW WITH GEORGIE ELSON

Interviewed by Michelle L. Hawes

I believe interviews of patients with acute and chronic conditions will best spotlight what life is like on the frontline when they are dependent on vascular access. The patient’s perspective can and should inform what we do and how we do it. For this issue of IV Quarterly, I interviewed Georgie Elson.

Georgie depends on central vascular access for hydration and multiple intravenous (IV) medications. Mx. Elson is a nonbinary patient with a complicated medical history that thwarts standard-of-care and underscores the need for vascular access specialists. A specialist needs a deep understanding of all options available for the nonstandard patient.

Georgie suffered a traumatic brain injury in 2016. As a result, their Ehlers-Danllos Syndrome (EDS) and Postural Orthostatic Tachycardia Syndrome (POTS) were exacerbated. EDS is a group of inherited disorders that affect connective tissue. This syndrome results in hyper-flexibility, fragile skin, and poor wound healing.1 POTS causes the heart to beat faster as an inadequate response to transitioning from sitting to standing.2

In addition, Mx. Elson has Mast Cell Activation Syndrome. This syndrome releases substances that produce signs and symptoms similar to an allergic reaction and severe inflammation.3 A daily necessity for hydration and other IV medications escalated their vascular access needs from an occasional short peripheral IV to long-term venous access.

According to Georgie, “My PICCs [peripherally inserted central catheters] would last 7 months at the longest before my skin would blister and weep from the adhesive stabilization or there would be an infection. Ultimately, my doctors advised that I switch to a Port [implanted vascular access device] to avoid adhesive issues, but they had to remove it when skin would not heal”.

Due to their EDS, the daily needle insertions and removals into the port eventually caused the skin to erode, exposing the silicone septum. Georgie then had a pediatric port placed in her chest near the right axillary fossa; unfortunately, poor placement, a right-handed person performing their access, and slow wound healing led to a port-pocket infection.

GEORGIE’S PICC AFTER 1 YEAR. ALLERGY TO CHLORHEXIDE. CLEANED WITH ALCOHOL AND BETADINE WEEKLY. DRESSED WITH SILVERLON5 & TEGADERM HP6

Mx. Elson explained what happened next, “I was back to a PICC after the ports, and the first PICC only survived 3 months. Because I am a full-time wheelchair user until I have bilateral hip surgery and my CSF [cerebral spinal fluid] leak has yet to heal, extra trips to the hospital are extremely hard for me, even when necessary. So although my PICC was working great, the blistered skin from adhesive securement was causing yet another catheter replacement and unnecessary trip to the hospital”.

Following the last PICC failure, Georgie consulted friends and social media support groups to find an answer to their securement problems. Even though Mx. Elson utilized multiple brands of adhesive securement throughout their life with a PICC, the same skin reaction impacted them every time. With the next PICC, they wanted to try something completely different.

Describing their discovery and use, Georgie said, “On social media, I found SecurAcath [subcutaneous anchored securement system] discussed by others with adhesive reactions. I researched the company’s website further and tried to figure out how I could get the device placed on a new PICC. The hospital I normally go to does not have this device and was unable to get it just for me. When they placed my current PICC on January 19th, 2022, they left 3cm out so I could get a Securacath placed later. After just 1 week with the standard adhesive securement, my skin was itchy, sore, and inflamed. I got the Securacath placed at home during a routine dressing change saving me an additional trip to the hospital. My Securacath held my PICC in place with no adhesive, no movement, and my skin reaction healed quickly. My home care nurse loves being able to clean all around the site without the usual adhesive gunk left behind.” 4

When asked about the difference between adhesive securement devices and subcutaneous anchored securement systems, they answered, “For me, there is no question that eliminating the adhesive was critical for me to maintain my PICC and avoid complications. With adhesive securement, I had constant itching, burning, and soreness under my dressing; with Securacath, there’s none. My home care nurse has gotten used to the Securacath holding the PICC in place while she cleans and dresses the site. She says she has never seen a better PICC site.”

“When I was dependent on various adhesive securement, my PICC would often back out a little with every dressing change, and sometimes my line would get shoved back into my arm accidentally. With Securacath, there is none of that because it stays with the PICC all the time. I have had my PICC for over a year and had the Securacath replaced once. Unfortunately, because of my unique connective tissue problem and the original placement near my elbow, the repeated bending eventually caused skin irritation after almost a year in place. Sadly, I had to make a 2-hour trip to the nearest hospital with Securacath as an option. It was quickly and painlessly replaced with a new angle to avoid a future issue.”

When asked what words of wisdom they have for the vascular access specialists who may read this interview, Georgie said, “I think Securacath should be at every hospital as a securement option. On social media, there are support groups for people dependent on central lines and many posts about reactions to adhesive securement. So if you are the vascular access specialist taking care of us and our lines, you should know that an alternative to adhesive can help save our skin and our lines.”

References

1. Ehlers-Danlos Syndrome. Mayo Foundation for Medical Education and Research. August 25, 2022. Accessed January 31, 2023. https://www.mayoclinic.org/diseases-conditions/ehlersdanlos-syndrome/symptoms-causes/syc-20362125

2. Postural Orthostatic Tachycardia Syndrome (POTS). Cleveland Clinic. September 9, 2022. Accessed January 31, 2023. https:// my.clevelandclinic.org/health/diseases/16560-postural-orthostatictachycardia-syndrome-pots

3. Systemic Mastocytosis. Mayo Foundation for Medical Education and Research. November 20, 2020. Accessed January 31, 2023. https://www.mayoclinic.org/diseases-conditions/systemicmastocytosis/symptoms-causes/syc-20352859

4. SecurAcath, For Patients. Interrad Medical. Accessed January 31, 2023. https://securacath.com/for-patients/

5. Silverlon. Argentum Medical. Accessed January 31, 2023. https://www.silverlon.com/products/catheter-dressings

6. 3M Tegaderm HP Transparent Film Dressing. 3M. Accessed January 31, 2023. https://www.3m.com/3M/en_US/p/dc/ v000058085/

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