Sunday, June 22nd - 4 Weeks Old

Kinley is 4 weeks old today. It is amazing to think about what she has been through already. The list is too long to imagine (or type), especially for an individual who is not even a month old. These CDH (Congenital Diaphragmatic Hernia) babies definitely have one of the roughest first months of life around. Kinley is still in a "critical" condition today and I know that Kinley is not "out of the woods" yet, but we are very happy with where she is now since she has already spent 3/4 of her life on a heart and lung bypass machine (ECMO) and undergone major surgery while on blood thinners.

Today however, is Kinley's third day of recovery from her diaphragm repair surgery and it is her second full day off of ECMO. Kathy and I tried to get caught up on some sleep last night and returned to Kinley's side around 10:30 am. Katie is back for a second day of Kinley duty. She gives us a quick update. They increased both of Kinley's morphine and versed drips, but she is doing well with her gas exchange. Over the night Kathy (the nurse) was able to lower some of the vent settings since Kinley was doing a better job of getting rid of her CO2. Her most recent blood gas shows that her oxygen levels are holding strong and her CO2 levels have come down. And lastly, Kinley is currently without any BP (blood pressure) medication.

For rounds today we had Dr. P and Dr. P. The overall decision by both doctors is to continue to try and wean Kinley on the oxygen level coming from the vent. They will now lower the vent's oxygen level as long as Kinley can keep the oxygen saturation in her blood above 93%. If Kinley's BP goes up today they will plan on using lasix instead of BP medication. Lasix is a diuretic and it will help Kinley urinate out any excess fluids. By lowering the level of excess fluids it should help to lower her BP. It sounds like the biggest part of Kinley's day today will be the replacement of her belly button lines with a PICC line and an Art line. The lines going into Kinley's belly button are being used to put in meds, nutrition and blood products. They are also used to draw blood for tests. Belly button lines are normally removed after one week of life, but Kinley was on ECMO by then and could not have them taken out while she was on blood thinners. The PICC line, which stands for peripherally inserted central catheter, will be used to input all of Kinley's meds and nutrition. The Art line (art is simply short for arterial) will be used to draw blood. A Mid line will probably be added tomorrow and it will be used as an all purpose IV. It can deliver both meds and blood products.

Brian, one of Kinley's previous nurses, came by around 3:00 pm to try and place a PICC line for Kinley. Brian allowed us to remain in the room as he worked, but we were not allowed to get too close because we needed to make sure the area he was working in remained sterile. Brian started the line in Kinley's right hand and the goal is to thread it up her arm and into her chest where it will end right outside her heart in her superior vena cava. Brian was able to get the to the middle of Kinley's chest, but the line wouldn't make the last turn to end by the heart. So Brian decided pulled the line back to end at Kinley's shoulder and make it her mid line. This means that Kinley's belly button lines will have to wait until tomorrow to come out. Barb or Mary Kay will try to place Kinley's PICC line tomorrow and they will most likely try to reach Kinley's heart by going through one of her legs and ending in the inferior vena cava outside Kinley's heart.

Next up, Dr. P! Dr. P was scheduled to try and place an art line for Kinley as soon as Brian was done, but we will have to reschedule for later today. Dr. P is thinking it will probably be later tonight before he can place Kinley's art lines. Art lines are a bit trickier to place because they go directly into an artery and tend to have a bit more bleeding involved.

Around 6:00 pm Katie and Sarah took a look at Kinley's dressing and decide that it needs to be changed due to the fact that it had soaked through in a few spots. I was able to help out with part of the dressing change because Katie needed to change all of the tubing for Kinley's drips. In reality I was more of a glorified arm and hand holder for Kinley while Sarah did all of the work. Overall the entire process went pretty smoothly and Kinley handled it really well. Early on she got a bit upset, but soon settled in as she got comfortable with all of the attention.

When Kathy and I return after shift change we find Kinley's newest victim, Debbie. (I am just kidding. Every nurse loves Kinley for her ability to send her BP through the roof and her never ending supply of urine soaked diapers.) And Debbie is in for a special treat tonight. Kinley's BP has been a bit high throughout the day and, instead of using BP medication to bring it down, the doctors have decided to give Kinley lasix which will cause her to pee even more than normal. (FYI - Kinley's urine output for the day shift was 7 cc/kilo/hr so it's not like she has been having a hard time going today.) Kinley's first wet diaper, after the lasix was given, was 225 grams. That is far and away her biggest diaper to date. It looks like Debbie is in for a long wet night. Sorry Debbie, but thank you for taking care of our little urine factory.

As of 10:45 pm the oxygen coming from Kinley's ventilator is at 43% and Kinley is still keeping the oxygen saturation in her blood above 95%. Way to go baby girl!!!