At around 4:00, Ayden's oxygen was increased from .1 to .5, so they began the oxygen wean yet again. He is currently on .15, so it didn't take long for him to recover. They tried another IV diuretic today; while it may have made him pee more, it didn't seem to help him get off the oxygen.
Ayden's chest x-ray was the same, and Ayden continues to clinically be a rock star. One wouldn't even know that anything was going on internally without the pulse-ox and chest x-rays. Dr. Doyle admitted today in rounds that he too felt "frustrated" by Ayden's current situation.
They did do a chest ultrasound, and Ayden has fluid in his lungs (we knew that); he also has a pocket of fluid outside of his right lung, which may or may not be inhibiting his ability to breathe. Dr. Doyle is speaking with the cardiac surgery team in the morning. If they determine the pocket of fluid is part of the problem, they will be faced with the best way to get rid of the fluid: chest tube or needle. If they believe that the fluid can be removed with a one time event, they will use a needle to draw out the fluid. If they believe that Ayden may continue to develop fluid around his lungs, they will put in a chest tube. Both solutions require a few hours in the PCCU under minor sedation (no ventillator!), and then he can return to his 6C room...
... or maybe Dr. Doyle's conversation won't even be necessary. Maybe God will grant us a miracle in the morning, and his chest x-ray will show clear lungs!
P.S. Ayden didn't seem to miss Methadone today. Tomorrow's response will give us a better indication of how he is handling the wean.
November 4, 2010
Caught in a Cycle
Early evening yesterday Ayden needed more oxygen-- back to .75 liters. Overnight, he received IV Lasix (instead of the scheduled PO), and he's now on .175 liters. Does any of this sound familiar to you?
This morning, when Ayden's resident, Alex, and the attending physician, Dr. Doyle, came to see Ayden, they asked if they could do anything for me. I hear this question asked every time an employee leaves Ayden's room, and I normally say, "No, thanks. We're fine." This time, I responded, "Fix Ayden," which, of course, implies that we are no longer fine. Dr. Doyle told me, "I'm trying, but I don't seem to be doing a very good job." I honestly don't know if what we are dealing with just needs more time or if the cardiac team on 6C need to be exploring some other possibilities.
Last night they checked Ayden's blood count to make sure he didn't need a blood transfusion. He doesn't. If today's chest x-ray doesn't give us some answers, Dr. Doyle wants to do a chest ultrasound. As usual, I will find out more at rounds.
Ayden did not receive Methadone this morning. Methadone has a long half life, so I'm not sure that we will see how it affects Ayden right away. I'm hoping that it doesn't bother him at all. Time will tell.
This morning, when Ayden's resident, Alex, and the attending physician, Dr. Doyle, came to see Ayden, they asked if they could do anything for me. I hear this question asked every time an employee leaves Ayden's room, and I normally say, "No, thanks. We're fine." This time, I responded, "Fix Ayden," which, of course, implies that we are no longer fine. Dr. Doyle told me, "I'm trying, but I don't seem to be doing a very good job." I honestly don't know if what we are dealing with just needs more time or if the cardiac team on 6C need to be exploring some other possibilities.
Last night they checked Ayden's blood count to make sure he didn't need a blood transfusion. He doesn't. If today's chest x-ray doesn't give us some answers, Dr. Doyle wants to do a chest ultrasound. As usual, I will find out more at rounds.
Ayden did not receive Methadone this morning. Methadone has a long half life, so I'm not sure that we will see how it affects Ayden right away. I'm hoping that it doesn't bother him at all. Time will tell.
November 3, 2010
AAAAAHHH!
I'm so tired of the pulse-ox. I know that you have heard us speak wicked things about the contraption. So many decisions are based on saturations, yet we often struggle to know what Ayden is satting based on the pulse-ox. For instance, right now, while he is sleeping and completely still, he is satting 74-80 on .075 liters. Only a few minutes ago, when he was awake, the pulse-ox machine was alarming that Ayden was satting 68-72 on the same amount of oxygen. Typically, one sats lower while sleeping than awake. When one is trying to wean oxygen, it becomes an impossible task. The nurses don't feel comfortable removing oxygen on a kid that appears to be satting in the high 60's or low 70's. I'm starting to feel like Ayden can't get any pinker from the small amount of oxygen that he is receiving, but we can't get the numbers to match his clinical appearance. AAAAHHH! I am frustrated and tired, and I feel like I am going to scream every time that stupid machine alarms... which is ALL OF THE TIME!
I just spoke with a nurse practitioner concerning Ayden's saturations, and she believes that we will be seeing the up and down numbers until Ayden's vessel actually clots from the catheterization coils. Waiting on the clot to form and Ayden's lungs to clear create saturation numbers that dip and climb. They have decided that the nurses should allow Ayden 5-10 minutes to dip and come back up before doing anything with his oxygen. Please pray that Ayden's system cooperates, so Ayden can consistently get enough oxygen to his body to be able to come off the nasal cannula.
Ayden's morning chest x-ray showed no change, so they feel comfortable keeping Ayden at his PO Lasix. We will anticipate tomorrow's x-ray results to see if two days on PO Lasix show the same or better findings. Please pray that the PO Lasix can do the trick, so we can be one step closer to going home.
Tomorrow morning Ayden will not receive his Methadone dose. His Methadone will go Q24, so he will get the evening one only. Lately, sedative weans have resulted in some form of withdrawal, which usually affects his respiratory system. The good part about doing the wean here is that he has the perfect support system, should he need it. Please pray that Ayden is able to handle the wean.
Phew! Did I mention that Ayden is sleeping?!?! I should be too!
I just spoke with a nurse practitioner concerning Ayden's saturations, and she believes that we will be seeing the up and down numbers until Ayden's vessel actually clots from the catheterization coils. Waiting on the clot to form and Ayden's lungs to clear create saturation numbers that dip and climb. They have decided that the nurses should allow Ayden 5-10 minutes to dip and come back up before doing anything with his oxygen. Please pray that Ayden's system cooperates, so Ayden can consistently get enough oxygen to his body to be able to come off the nasal cannula.
Ayden's morning chest x-ray showed no change, so they feel comfortable keeping Ayden at his PO Lasix. We will anticipate tomorrow's x-ray results to see if two days on PO Lasix show the same or better findings. Please pray that the PO Lasix can do the trick, so we can be one step closer to going home.
Tomorrow morning Ayden will not receive his Methadone dose. His Methadone will go Q24, so he will get the evening one only. Lately, sedative weans have resulted in some form of withdrawal, which usually affects his respiratory system. The good part about doing the wean here is that he has the perfect support system, should he need it. Please pray that Ayden is able to handle the wean.
Phew! Did I mention that Ayden is sleeping?!?! I should be too!
November 2, 2010
To Fill Ya In
Since I am completely exhausted, I will try to make this quick.
Yesterday afternoon Ayden became very fussy. The only thing that settled him was riding in a red wagon around the unit... for two hours. (Havilah's idea) His heart rate stayed unusually high, even perched on his wagon throne. Eventually his sats dropped into the 60's.
Over the past few days, Ayden has had one sedative wean (Methadone) and another fall off (Ativan). It is possible that he was beginning to experience withdrawal. It is also possible that he was just oxygen deprived. Havilah put him back on the nasal cannula at .7 liters, and he has been on oxygen ever since. (Now he is on .1 liters.) We chose not to add the sedatives back to where they were, and I think that turned out to be a good decision; we didn't want to deal with the same withdrawal at home and just end up coming back to the hospital again.
Ayden's chest x-ray this morning was better, so they started him on PO Lasix. Tomorrow's chest x-ray needs to be better, or they will start the process all over again.
Ayden is doing well with his feeding. He likes sweet potatoes, peaches, and carrots. (Yes, those are all orange!) Today was the first time that I have fed him with a spoon! This morning he also began sucking on his pacifier again; he hadn't done so for weeks. We are hoping to tackle the bottle again soon... maybe tomorrow...
ZZZZZ....
Yesterday afternoon Ayden became very fussy. The only thing that settled him was riding in a red wagon around the unit... for two hours. (Havilah's idea) His heart rate stayed unusually high, even perched on his wagon throne. Eventually his sats dropped into the 60's.
Over the past few days, Ayden has had one sedative wean (Methadone) and another fall off (Ativan). It is possible that he was beginning to experience withdrawal. It is also possible that he was just oxygen deprived. Havilah put him back on the nasal cannula at .7 liters, and he has been on oxygen ever since. (Now he is on .1 liters.) We chose not to add the sedatives back to where they were, and I think that turned out to be a good decision; we didn't want to deal with the same withdrawal at home and just end up coming back to the hospital again.
Ayden's chest x-ray this morning was better, so they started him on PO Lasix. Tomorrow's chest x-ray needs to be better, or they will start the process all over again.
Ayden is doing well with his feeding. He likes sweet potatoes, peaches, and carrots. (Yes, those are all orange!) Today was the first time that I have fed him with a spoon! This morning he also began sucking on his pacifier again; he hadn't done so for weeks. We are hoping to tackle the bottle again soon... maybe tomorrow...
ZZZZZ....
November 1, 2010
Trial and Error
Dr. Doyle was hopeful that Ayden would go home today, but when he saw the x-ray, he changed his mind: "That's not a going home x-ray." The x-ray was a tad bit worse, so they now know that Ayden was not on enough PO Lasix yesterday to use as a home regiment. Now they have to back up, put him back on IV Lasix today, and see how tomorrow morning's x-ray looks. Based on that x-ray, they will determine whether or not they can try PO again, this time at a higher dose.
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