Baby Eagan - NICU Day 70 - Sixth Surgery

Getting prepped for surgery.

His IJ line after the sutures were removed.

  What a day Eagan has had. First, we took him down to radiology to get a lower GI study. He was taken out of his bed, unhooked from the ventilator, put in a transport isolette, hooked up to another ventilator and all of his machines were unplugged and brought with us down the hall, into an elevator, then down into radiology. A small catheter was inserted into his mucous fistula, the part of his intestine that is outside of his body. Contrast solution was ran through the tube and we watched it go through his intestines on a fancy X-ray machine called a flora X-ray. It can take almost constant pictures as the contrast dye runs through him. I got to watch the whole thing and thought it was pretty neat. The ventilator had to be unhooked to get him on the table, so a respiratory therapist bagged him with a resuscitation bag the whole time. It was pretty difficult because the catheter in his mucous fistula did not want to stay in place. He was put back in the isolette with his IJ line in his neck still properly in place. Once he was back in his room and ready to be unloaded, it was discovered that the IJ line came out but the sutures or stitches that held it in place were still there. He bled a decent amount but was okay. This was his only access other that peripheral IVs that can't run his nutrition or some of his medications. Surgery was immediately called. He went into surgery to get a line and almost 5 hours later he finished. In the process, four incisions were made, two central broviac lines were attempted and both failed. His IV in his head infiltrated and medicine leaked into his tissues. He now has a white circle on his head about the size of a quarter that will have to be watched closely. Finally, a femoral line was placed in the bend between his thigh and groin. This isn't so great since it is in his diaper area and will be hard to clean, but right now, vein access for medications is paramount. Hopefully, tomorrow will be much calmer. His GI study looks like it went well, but we are still waiting on the final word on that. 

Weight
3 lb 11.5 oz

Breathing
Eagan is on the conventional ventilator. His settings are at 33 breaths per minute. His oxygen rate is around 25%. The pressure that the ventilator puts in his lungs is at 20. Also, he has fluid in his lungs so he is getting Atrovent breathing treatments every six hours.

Vein and Artery Access 
Eagan lost the IJ line today and gained a femoral line in his upper thigh.

He has an IV in the top of his hand.

He has an arterial line in his left foot.

Medications

An antibiotic, Oxicillin is being given every six hours. 

Hydrocortisone, for blood pressure and stress response, is down to once every 48 hours.

He is now only on Morphine every 6 hours.

Caffeine has been started as a diuretic to try to speed up his kidney function.

He is also on Diflucan as a preventative measure.

He is also on Zantac to help calm his tummy's acid levels.

Lasix, a diuretic, will be given every 12 hours along with Albumen, a protein that makes up the majority of our blood.

 

He is back on Synthroid for low thyroid..

Nutrition 

8 cc's of breastmilk every 3 hours! He is still getting TPN and lipids also.

 

Output

A lot of pee today. He is putting out a good bit of poop from his ostomy, but since his intestines tore in such a high area, he is not digesting much of his food.

Transfusions 

June 14 - Transfusion #27

Upcoming Tests

Another eye exam to check on the severity of his retinopathy of prematurity will be next Thursday.

Cranial ultrasound at 36 weeks gestation.