Update From Sunday 12/21/08

I typed this on Sunday morning 12/21/08 and then couldn't get access to post it...

Last night (Saturday night 12/20), sometime before 3 Katie's IV pump beeped with a message of "infusion complete." This usually means that the nurse didn't keep track of her pumps and how much time they had left so that she could get in and reset it without waking her patient. So when it beeped again around 3 I was annoyed, I didn't even look at what it said I just pushed the nurse call button (which we almost never do.) Well it said "patient side occluded." Sometimes that just means she needs to kind of shake out her hand or straighten it and then the pump needs reset. This time... not so much... the part that goes inside of her vein had backed out and was in the shape of a Z, so it was ruined. So I got up to start negotiating on Katie's behalf to not restick her right then in the middle of the night. I figured since her next abx dose was due at 5am and her Prograf level blood draw was due at 6:45 that we make the abx a little late and just do one stuck and wait until 6:45 to do it, particularly since her fluids were due to be discontinued today anyway. I had to argue a bit ut we got there.

Two residents showed up at 7:15 (grrr) and missed the first stick all together. So I agreed to let them just do a regular blood draw so that her Prograf level wouldn't be any later than it already was and we would regroup. The resident doing the sticking was clearly "done" because after the blood draw stick (which was thisclose to going badly) she said "well I'm off duty now so another resident will be back to try again later." Oh, nice, sorry to have bothered you. One of the nurses on the floor had been following along with us and had help me convince them about delaying the orginal restick, and she asked to try to put another IV in, and I let her... that one "blew." When you place in IV you check it by using a syringe of normal saline to "flush" the line, if it flushes and flushes easily then you have a good IV. If it's hard to flush it's a bad IV, or you see a bump form under the skin as you flush it's "blown" and the fluid is now collecting under the skin instead of going through the vein. At this point we had a freshly lost IV site in the left hand, a failed IV placement attempt in the right arm inside the elbow, a fresh blood draw site in the left arm inside the elbow and a freshly blown IV site in the left hand (yes that's two in the left hand because we're trying to keep her able to do crafts.) So we asked for a PICU nurse as usually they’re more skilled and experienced at placing IVs in kids and babies. Later, at close to 9, a very nice, experienced, skilled PICU nurse came over. Getting another IV placed was really hard on Katie because that left hand is so sore, and she cried and cried, but we got it in and if flushed beautifully. We had a small snafu with it not being tightened together strongly enough but we held it together, cut away some of the tape and retaped it.

And that’s where we are. Her antibiotics schedule is now 9am and 9pm which is actually a good time schedule to go home with and it makes it more likely that we can get sprung tomorrow afternoon since the next dose won’t be due until 9pm.

Childlife is supposed to come by any time now to talk to Katie about the PICC placement process. I hope I won’t have any more updates for you until tomorrow afternoon.