Sunday, June 29th - Switching Vents & PICC Lines

Yesterday was an okay day for Kinley. There were no huge leaps forward, but there weren't any big set backs either. She is continuing to fight with withdrawals (vomiting, sweating, easily agitated, sneezing and extra secretions from her lungs), especially now that her morphine drip is completely gone. Her methadone doses, which are given every 6 hours, seem to curb her withdrawals for about 3 to 4 hours, but then she typically requires an extra dose of morphine to get her through until her next scheduled methadone dose. Kinley required 3 extra doses of morphine yesterday, one during the day and two during the night. The support from Kinley's high frequency vent was turned up a tiny bit last night because the CO2 levels in her blood were a bit high, but they did not need to increase the percentage of oxygen coming from her vent. The oxygen from Kinley's vent was around 35% and her blood oxygen saturation remained in the low to mid 90s all day.

When we arrived today there was a large crowd around Kinley's bed station. "Did Kinley decide to throw a party and not invite her parents? I mean, I know she has her own place now, but come on!" The crowd that had gathered (2 respiratory therapists, a nurse practitioner, Kinley's day nurse and Dr. K) was actually there to switch out Kinley's vents. Right as we walked up the respiratory therapists switched Kinley from the high frequency ventilator to the conventional ventilator. The respiratory therapists stayed for a little while after the switch to make sure Kinley did not need to go back on the high frequency ventilator. She did not, Kinley was able to maintain her blood oxygen saturation in the mid 90s and her blood CO2 levels are within range.

Shortly after the vent change Dr. K, Delores (the nurse practitioner) and Katie (Kinley's day nurse) take a look at Kinley's right leg. (FYI - Katie was Kinley's day nurse for a few days after Kinley came off of ECMO, but when she was still in the operating room.) Kinley's right leg is the leg that her PICC line goes through. The PICC line is the IV line that runs, inside a vein, from Kinley's right foot and ends just outside of her heart. It is used to give Kinley all of her meds and nutrition. Kinley's right leg looks red and irritated and it is definitely sensitive to the touch. She gets very upset whenever somebody touches it. Dr. K informs us that there are two reasons why this might be happening, but they are both connected with Kinley's PICC line. The first is that Kinley's PICC line is simply irritating the vein it runs through and causing it to become inflamed. The second is that the PICC line has given Kinley an infection. Either way, the PICC line needs to come out as soon as a new PICC line is put in. Later today Brian, another nurse, will attempt to place a new PICC line. He will try to place it Kinley's left arm because Kinley's other extremities are already in use. Her right arm already has her Mid line and her left leg already has her Art line.

Rounds were done before we arrived, so Katie gives us a quick update. No big changes other than the ones we have already witnessed or heard directly from Dr. K. Kinley's methadone dose and versed (sedative) drip will remain constant for today.