Capt Snuggles is 7 months old today.
He should be able to sit unassisted, he should be able to roll, he should be working on the whole crawling thing. He should be able to hold toys in his hands and he should be able to sit in his high chair or walker and munch on cheese doodles and baby cereal. He should be drooling with all the teeth he’s getting and he should be squealing with laughter when the dog licks his face. He should be working on the word’s “mama”, “dada” & “ball”. He should be home.
Instead, I’m wishing I could say we celebrated with balloons and cupcakes.I’m wishing I could take his picture. I’m wishing I could rattle off all of the baby milestones that he’s reached. Hell, I’m wishing I could say we had an uneventful day.
But, I can’t.
I was all set to sing the praises of the Surgeon who finally, after 3 days and 8 different doctors, finally got the arterial line placed.
But that was Friday night. And if I hadn’t been so exhausted, again. I would have written an entirely different post than this one.
As it stands, the Surgeon did succeed in placing the arterial line, no cut-down required. Everyone breathed a sigh of relief. Myself included.
That was @ 6pm.
Around 10pm, his PICC in his left leg stopped working. It was the 2nd time that day that the PICC had occluded. The Chaperone’s replaced the IV tubing the 1st time. This time it was further in, probably clotted in the vein. They contacted the central line nurse on call. There’s a drug called TPA that breaks up clots and only the CVC nurses are allowed to administer it. Of course, she wasn’t in the hospital, so it was about midnight when she showed up.
It’s silly, really. All she did was inject the TPA into the PICC, like any other IV med. She told the Chaperones (we had 2 again on night shift) to wait 2 hours, if it still wouldn’t flush, then wait 2 more hours. If it still didn’t work, she’d either come back (yeah, she only came to administer the TPA) or the day-shift nurses would be ready to come in – they could come and take a look.
Frustration aside, this was the line that had his TPN (nutrition) in it. So until it was fixed he had to go on maintenance fluids since his access was limited. Many of the antibiotics and pain meds are incompatible with TPN, so it basically needs it’s own line.
Fast forward to 6:30am and I wake to the PICC – broken. The catheter was still in his leg, but the ‘hub’ had apparently broke in half. So now they had to either try and salvage it or place a new one.
Oh – and did I mention that by now – the arterial line had also quite working? That’s right – I woke Saturday morning to a broken PICC and an unusable arterial line. The Fellow had already contacted the Interventional Radiologist to see about re-wiring the existing PICC.
The decision was made to do without the arterial line. Unless he takes another turn for the worse, they are willing to wait and see if he can do without.
We had to travel in order to go to IR. That meant the Fellow, both our Chaperones, the RT and the PCA all had to help transport him. Sorta like a parade, but without the fire engines and candy.
The bad news is they couldn’t savage the PICC. (1 1/2 hours to try)
The good news is, the IR doctor was able to place a new PICC in his other leg on the first try. (1/2 hour start to finish)
I Love You, IR!
Back upstairs to finish the dressing change and
brachycardia, again. And not just for a few minutes, and not just dips into the 60’s . He was ‘brady’ for a solid 1/2 hour and dipped all the way down to 45 heartbeats per minute. This is the 3rd time in as many days and no ‘vagal’ suspected, soooo…..
Time for atropine.
They tried for an EKG, but the leads won’t stick to his skin, because, well, he doesn’t have any. At least not enough good skin, his belly, chest and back are still quite weepy and oozy. Blood work showed a very low potassium level, he was more acidotic than earlier in the day and his body temp had dropped down to 91 degrees.
They needed to warm him up and fix his potassium. Once his heart-rate was stable, we quickly finished the dressing change, turned on the warmer for his IV fluids, piled warm blankest on him and added not 1, but 2 warming blankets, one under and one over him.
We had him cooking like a baby toaster strudel.
It’s now midnight. All has been quiet for a couple of hours. His TPN has been re-started, so his electrolytes should be better by morning. His heart-rates have been good and he’s been resting comfortably.
I saved the best nugget of hope to share with you here at the end. I’m almost afraid to say the words out loud. So many things have just gone wrong this week…
I want to share with you that his skin is looking better. Not just a little bit better, either. More like
WOW! HIS SKIN IS LOOKING BETTER!!!!!!!!
ssshhh! Don’t say it so loud!
Maybe, one day soon, I will be able to take the Captain’s picture again.