It has been a long day, week, admission…
We went down to the OR around 1:3o. They were ready for our girl. Dr. K explained his plan and told us that it was going to take him as much time as it would take him…words that were both comforting as well as worrisome.
(Dr. K made Lucy a tiny gauze heart to cover up her sutures:)
A little over an hour later he came out and told us that things went well. He had a surgery fellow assist with the procedure, Dr. K said that he was breathing down his neck the entire time. He explained to the fellow that this CVL surgery is life saving surgery for our girl, without this line she would not be here. Dr. K is very particular about how he places a line in a kiddo like ours…in other words he told the fellow not to screw up!
When Lucy came out of the OR that is when things became difficult. Dr. K left her femoral line in because she was still infusing her antibiotics through that line. The plan was to get her to the pediatric anesthesia care unit (PACU) and pull her femoral line before she woke up fully from anesthesia. Once they began snipping the stiches on Lucy’s leg she woke up, and might I add, not happy!
They called us back just as soon as her fem line was pulled. She was unhappy and made sure everyone knew about it. We were waiting for radiology to take an x-ray of her new line so that we could get the ok to use it. This is when I noticed that they were only running D5 through an IV in Lucy’s foot! Lucy is used to triple the amount of dextrose at quadruple the rate they were infusing it. Needless to say her glucose plummeted and the PACU went on a wild goose chase to find Lucy’s TPN, you can’t connect her old TPN line to a new clean line because of the risk of infection. Only here’s the problem, TPN was never ordered for Lucy tonight as we were planning on going home this evening on our home TPN bags. This caused quite a stir in the pharmacy, on our floor, and in the PACU… what fluid were they going to give Lucy? As we were waiting for a higher dextrose fluid to be ordered for our girl I instructed the PACU nurse to bolus Lucy 60cc’s of D10 straight into her IV to help bring up her glucose, this is when the nurse told me she needed to get orders to do so…really!?! Thankfully a nurse who knows Lucy from the ER was working in the PACU, she remembered Lucy’s hypoglycemia issues and agreed to blousing her, telling the other nurse that mama knows best. Oh the drama…it only continued when they were trying to figure our what rate to run her D10 at, nobody could seem to get an answer. Poor Lucy she was cranky and irritable and her parents were quickly feeling so as well.
We left the PACU just as quickly as the nurse could document all that needed to be documented and we were returned back to our room where they immediately doubled the rate of Lucy’s D10 infusion. When we arrived were still had not received word that we could use Lucy’s new line. People started panicking as we only had one point of access, in Lucy foot mind you, to infuse everything. The IV team nurse finally got approval to use the line, this is when we noticed that one of the lumens on her line would not flush…ugh! The hope was that it clotted off and we could fix it by locking heparin in it for an hour to break up what if anything was blocking the line. This is when we made the decision to stay another night instead of going home.
The line is working and we are able to run continuously through it, but it is sluggish. We are going to talk to surgery about the line in the morning. As for tonight, we are working on getting Lucy back on schedule with all of her meds. She is on an every six hour med schedule with her antibiotics that run for two and a half hours, thirty minutes prior to running her antibiotics we need to infuse IV Benadryl and IV Tylenol to help with the red mans that Lucy gets from the vancomycin. This is in addition to the nine other med infusions that we run daily…yeah, sleep is going to be an issue this week.
Even though we are anxious to go home, I am welcoming the nursing help tonight as we work at getting Lucy’s meds back on schedule. We have just “a few” details to work out in the morning, but we should be all set for discharge sometime tomorrow morning.