What a Day!

Update: We had to call an ER nurse up to the floor (after the PICU nurse gave up) to put Rebekah's IV in. Even though I did not want to have the IV in her scalp, that's where it went. I don't have a problem with it in her scalp, just that she always pulls them out and we have to start all over. Just pray that this one stays in until we no longer need it!

Original Post: Just when things were starting to get a little calm around here, our little hospital world went crazy! This afternoon was so calm and peaceful with only 12 patients on the floor. In fact, it was so calm that they sent our nurse home and we had a new nurse, Noelle, who is very sweet. Then the chaos started. There was a fire (albeit a small one) in the NICU downstairs, there was a domestic altercation on our floor resulting in a visit by our friendly local sheriff's department, there was a disgruntled patient complaining about a nurse resulting in the nurse manager being called in, and lastly there was a suicide in the parking garage. Oh, and within the space of an hour, our floor received three new patients. I think I'm ready to move out!

So, in the midst of all of that chaos, Rebekah's IV blew out in her foot. She had been getting fussy, but I figured she was just ready to eat. So I was pumping and getting her bottle ready when I noticed her sock was wet. Her IV solution had finished earlier and our nurse had changed out the bags and was holding on to Rebekah's sock while she was working on putting in the new bag, so I figured she had just gotten the sock wet then. So I proceeded to give Rebekah her bottle, which she drank a little of and then kept getting more and more fussy. She kicked her foot up in the air and I saw that it looked a little swollen. When I looked more closely, I realized that the gauze and padding around her IV was soaked with solution and her foot was very swollen. I immediately stopped her pump and called for the nurse. They determined that the IV had, in fact, blown and went to talk with the attending doctor (Dr. Brown, affectionately known as Dr. Seth - he's in residency and is going to make a terrific doctor!). Dr. Seth spoke with Rebekah's cardiologist and they decided that she really needed to have the IV fluid to keep from dehydrating, which is what happened during her last hospital stay.

Five nurses and four attempts later, we still do not have an IV in yet. Rebekah has great scalp veins, and an IV can usually be placed in one attempt in her scalp, but she pulls them out within hours, forcing us to repeat the whole process. I am very protective of her left hand because she sucks on those fingers as her comfort measure, so I don't want the IV in that hand/arm. That leaves one arm and two feet. We are waiting on a NICU nurse to come and attempt an IV since they are used to dealing with very itty bitty veins. Hopefully we will get something soon.

When the nurses took the pulse oximeter off Rebekah's foot, we realized that her foot had blistered underneath from the tape used to hold it on, so she has a nice raw spot on her foot. I don't think Rebekah has a latex allergy or anything like that, but she definitely has sensitive skin. That pulse ox had been on since we arrived in the ER Monday night, so I probably should have requested that it be changed. Just one of those things I didn't think about, but will be more aware of in the future!

When Dr. Markowitz came by this morning, he wrote orders for an NG tube (the feeding tube through the nose) to be placed under x-ray and for continuous feedings to resume. Rebekah had an NG tube for several weeks prior to the g-tube being placed, so we have been this road before. The hope is that she will be able to have continuous feeds through the NG tube just until her new g-tube arrives and we can have it changed. If the feeds through the NG tube are successful, we will be allowed to go home and wait for the tube at home. If not, the doctors will do some more checking to see why she is not tolerating the tube feeds.

We did a trial run of the NG tube for about an hour around 6:00 this evening, and it seemed like she tolerated it well. We will be using it through the night and reevaluate tomorrow. But it looks possible that we might actually go home tomorrow. We'll see what happens.

Please pray that we will be able to get this IV in to run fluids until Rebekah gets back up to full continuous feeds again!

Nancy