In December 2000 I entered hospital to be given a stem cell transplant and chemotherapy for the treatment of a form of cancer called Non-Hodgkins Lymphoma.
Before the treatment started I was taken to a clinic where a surgeon was to insert a tube into my chest. This tube was called a central venous catheter or CVC. As I laid on a bed a nurse brought in a package sealed in plastic. When the surgeon unwrapped it he withdrew a cleaned and sterilised cotton surgical gown and mask and plastic gloves. He then opened another sealed plastic bag which covered a surgical tray containing a variety of sterilised instruments and other items. Sterilised swabs were then used to clean my chest near my right collar bone and a sterilised syringe was used to punch a hole in my chest, and then a sterilised tube was fed into an artery under my skin and pushed toward my heart. After this procedure was completed the tube was stitched in place with about 6 inches protruding outside of my chest where it divided into 3 branches which were each capped at the end. I was instructed to clean the stitched area each day to prevent infection and that the tubing could then be kept in place for several months during my hospital stay and at home until I had recovered from the treatment. I was then taken back to a private room in the cancer ward.
The reason so much care was taken to prevent infection was because the stem cell transplant and the chemicals completely destroys the immune system so any contracted infection can be fatal. The ward floors and bedding were also thoroughly sterilised and the air was filtered.
Soon after returning to the ward a nurse entered the room and put on a surgical gown and mask and gloves and placed a bag of chemicals on a 6 foot high stand near my bed. A tube from this bag was fed into a machine which regulated the flow of chemicals and then the end of the tube from that machine was plugged into one of the branches of the tube in my chest so that chemicals started entering my blood stream. The nurse then placed another tube on the stand and repeated the process so that 2 bags of fluids were draining into two of the branches of the tube in my chest. The second tube could later carry other chemicals, or nutrients as required by the patient. The nutrients were provided because the chemicals caused nausea and throat ulcers which made it difficult to eat by mouth. The third branch of the tube in my chest was left free so that blood samples could be taken daily, or when required.
Within a few hours of the chemicals being given I became nauseous and began to vomit impulsively and violently which required me to jump out of bed and vomit into a bowl on the right side of my bed, and within a few moments I had sudden diarrhoea which required me to leap frog over the bed and sit on a commode to empty my bowels, and a few moments later I had to get out of bed to urinate urgently. These things happened so suddenly that I tended to get tangled in my tubing and to place strain on the stitches which were holding it in place in my chest.
The problem was compounded by the fact that I had a thin physique and it was summer so I generally felt cold in the air-conditioned wards of the hospital so I wore thermal T-shirts. One was a polo neck and the other had a broad neck. However I had been advised to wear a button up shirt so that the nurses could access the tubing in my chest easily, but I did not have such a shirt with me.
As a result, whenever I moved in the bed the tubing tended to drag on the neck of my T-shirt causing strain on the stitches which held it in my chest. In addition to this, whenever the nurses came to check my tubing or do a blood test they would have to reach clumsily into the neck of my T-shirt to find the tube, and then awkwardly drag the tangled tube out, invariably pulling on the stitches in my chest.
I was also given antiseptic swabs and instructions on how to clean around the catheter insertion site to prevent infection. I had to do it myself, rather than have the nurses do it for me, so that when I left hospital a month later I would be able to keep the wound clean at home. However, because of the side-effects of the chemotherapy my fingers seemed to be slightly numb and not as nimble as usual, and because I was feeling nauseous and ill and because of the position of the tubing in my upper chest I found it difficult, and in fact impossible to bend my neck far enough to look down to see the insertion site directly. Also my eyesight was not good and I found it difficult to see the wound in the mirror because the line across my bifocal lensess was getting in the way, and it was difficult to coordinate the cleaning process because the mirror image is the opposite of the wound. Therefore in my clumsy attempts to clean the skin around the catheter I often felt sharp pain as I knocked the catheter.
Eventually, on the third day I rolled over in bed and the tube pulled on the neck of my T-shirt and dragged on my chest causing it to be sore and within the next few hours I noticed that my T-shirt was getting wet. This was because the fluid was leaking out of my chest at the entry site of the tube. A nurse then came to inspect the tube and noticed that it was leaking, and also that, as a result, my skin was showing signs of infection, so the tube had to be removed.
A specialist told me that this would make it difficult to provide me with intra venous nutrients in the future, and that consequently it would significantly reduce the chances of me making a long term recovery from the cancer.
For various reasons, including my poor condition following the transplant, it was not possible to insert another catheter directly into my chest so several attempts were made to get a different type of tube, called a picc line, into my chest via my arm, but each time the tube became stuck in the armpit area and had to be removed. The only alternative was to insert two tubes, called jelcos into my left wrist and the chemicals were inserted through them.
These tubes presented a few limitations and problems. For example it was not possible to deliver nutrients through them so my only source of nutrition for the next two weeks was vitamin enriched liquid milk mixtures which I forced myself to drink despite the problem of severe nausea. Also the jelco tubes became infected more easily and so were routinely removed each second day and then two new ones were inserted into my right wrist and then plugged into the chemical tubes. This change of tubing occurred every second day for the next month. Also it was not possible to take blood samples from them so an injection had to be inserted into my arm at least once a day for blood tests to be taken. In other words because the one chest tube had to be removed I had to have 60 additional injections in the following month, which were all given while I was quite unwell.
I thought that I might have been able to prevent the problem by not wearing the thermal T-shirts and by keeping myself warm by some other means, and that I could redesign my own T-shirts to overcome the problem if I had to have similar treatment in the future. I also considered the fact that many other patients would have exactly the same problems.
This T-shirt would be a slight modification of my own open neck thermal T-shirt with two cuts down each side of the neck for about six inches so that a flap in front would leave the shirt open with easy uncomplicated and fully visible access to the tubing in my chest. After the tubing had been inspected or used for blood tests the flap could be simply replaced and held in position by moderately secure velcro strips until the next blood test. If the velcro had moderate strength then any pulling or strain on the tubing would tend open the flap and give the patient advance warning so that they could stop rolling in bed before the tube dragged on the stitching in the chest. By this means thousands of patients around the world could avoid the months of inconvenience associated with the removal of the CVC. The improved success rate would also reduce the costs of treatment.
I call this T-shirt design The C-shirt (The CVC or Cancer Shirt) and recommend that it be included in the kit which is given to the surgeon when the tubing is inserted. (The surgeon would get his gown, mask, and gloves, and the patient would get his C-shirt). The benefits would far outweigh the very slight cost, and if this became an accepted idea I presume that I would be entitled to a small royalty for each C-shirt.

Max Banfield

P.S. On previous hospital visits I had become cold due to the hospital air-conditioning, so prior to going on this occasion I packed two of my thermal T-shirts so that I could keep warm and so that, when one was being washed each second or third day, I could wear the other. I also purchased 3 knee length T-shirts which were labeled as 'one size fits all'.
However I had not had a stem cell transplant or a CVC before so I was unable to predict or prepare for the treatment and I am sure that other patients would have the same problem.
I therefore suggest that the CVC kit include two different sized C-shirts of moderate warmth characteristics to suit most patients and the benefits would still far outweigh the costs. M.B.