When we arrived at Kinley's bed station today we noticed that something was different. Apparently Kinley felt like her crib needed something more, so she asked Holly (one of Kinley's previous nurses) to get her a mobile. (No, not a mobile phone. We are not ready for those bills yet.) Holly made a very good choice because Kinley loves listening to her new music and watching her buddies fly around above her. I feel pretty confident in saying that Kinley will not miss staring at the ceiling tiles.
During rounds today Dr. C decided to keep Kinley's methadone, ativan and erythromycin doses exactly the same as yesterday, but she will increase her continual feedings from 15 ccs per hour to 19 ccs per hour. Now that all of Kinley's medications go through her NG tube and into her stomach there is not a need for her to keep her mid line IV, so Dr. C places an order to have it removed today. That will leave Kinley with only on IV, her PICC line. Currently going through her PICC line are lipids (fats) and TPN (nutrition). Kinley has been receiving lipids and TPN for the vast majority of her stay here at Children's Mercy, but since Kinley is eating more on her own there will need to be a few changes made. She is getting plenty of lipids through her feedings so they are going to stop her IV lipids completely. Kinley's TPN currently has Zantac in it to help with acid reflux and/or stomach irritation. Kinley has not shown any signs of acid reflux, but CDH (congenital diaphragmatic hernia) babies are known for having reflux due to the fact that their intestines had been out of place for so long. Today they will stop giving her Zantac through her TPN and start giving directly through her NG tube. But the biggest news in rounds today is that they will begin the final phase of weaning Kinley off of her nasal cannula.
The final phase of oxygen support weaning is much more involved and lengthy than I would have thought. Kinley is currently receiving 21% oxygen (room air) at a flow rate of 0.5 liters per minute through her nasal cannula. They will increase her oxygen support to 100% oxygen and then begin weaning her flow down 0.1 liters at a time. As long as Kinley keeps her blood oxygen saturation in the mid to high 90s they will continue to wean. The lowest they can wean her flow to is 0.1 liters per minute. Once she is down to 0.1 liters per minute of flow they will begin to wean the oxygen support down from 100%, until she is at 21%. Whenever Kinley is able to reach 0.1 liters per minute of flow at 21% oxygen they will be able to remove her nasal cannula.
Nancy, the OT (occupational therapist), stops by Kinley's bedside around 1:45 pm to give Kinley her second bottle feeding every. Kinley had her first bottle feeding yesterday and she ate 8 ccs without having any issues. Today the goal for Kinley is to take 10 ccs without coughing, gagging or choking. This time Nancy feeds Kinley while she is sitting straight up instead of on her side like yesterday. This will give us a better idea on how well Kinley can take to bottle feeding. Kinley give Nancy another surprise today and finishes her 10 ccs, without any problems, in about 3 - 4 minutes.
Ashley, Kinley's nurse, has been lowering her oxygen flow all day and around 4:00 pm Kinley is turned down to a flow of 0.1 liters per minute. Now the only thing left to wean on her nasal cannula will be the percentage of oxygen being provided. If Kinley can get her oxygen support down to 21% without dropping her blood oxygen saturation below the mid 90s she will be ready to try life with any type of oxygen support.
Around 5:00 pm Kinley's streak of poopy diapers continues. And yes, they are still very runny. Yea for diaper changing! This time I didn't get any extra diapers dirty, but we did have to put one of her blankets in the wash. Probably around the time I finished fumbling around getting Kinley's diaper changed Ashley came to check Kinley's residual. It was a tiny 5.5 ccs and that was with Kinley new continual feed of 19 ccs per hour.
At 6:00 pm Ashley makes the first adjustment to Kinley's oxygen support by turning it down from 100% oxygen through her nasal cannula to 90%.
After shift change I return to find that Barkley (Kinley's night nurse) is back again tonight. Last night, Barkley gave Kinley her first official bath. Kinley was actually sitting in a tub of water.
Around 9:00 pm I find that Kinley has yet another poopy diaper. The streak is still alive! Yes, this diaper is just as runny as the last, but this time I don't get anything extra dirty. As soon as I am out of the way Barkley gets in with Kinley to check her residual. This time it was a minuscule 3.8 ccs. Way to go baby blue eyes!
At 9:30 pm Barkley turns Kinley's oxygen down to 80%. At 10:30 pm she turns it down again to 70% and at 11:00 pm it is moved down to 60%. Kinley has continued to keep her blood oxygen saturation in the high 90s and has hit 100% quite often through this entire weaning process.
Night rounds stop by Kinley's bedside at 11:10 pm and they give Barkley the green light to turn Kinley's oxygen support all the way down to 21%. Kinley is now at the least amount possible for oxygen support and she is still keeping her blood oxygen saturation in the mid 90s. The only then left to do now is remove the nasal cannula and see how she does on her own. But for me, I need to go home and get some sleep. Kathy and I are hoping that tomorrow will be a nasal cannula free day.
1 comment:
Way to go Kinley- Sounds like you are well on your way to going home. Your strength is so inspiring- we hope that our little girl will take some pointers from you and be just as quick to recover! Keep up all the hard work.
The Reeds
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