Kathy and I arrived this morning to find Kathy (a surgeon) and Brecklyn (Kinley's nurse today) hovering over Kinley with the bed lights on. What's going on? Kathy, the surgeon, is here to clamp Kinley's chest tube, clean her surgery site and also remove some, not all, of the sutures from Kinley's diaphragm repair surgery. Kinley is kicking and silently screaming, even though Brecklyn has already given her an extra dose of both morphine and versed. Kathy, the surgeon, was able to clamp the chest tube and remove a few sutures, but not as many as she was hoping for. Kinley is simply moving too much for her to work safely with sharp scissors. If Kinley is able to get her head MRI today then Kathy will return after to finish. The reason Kathy wants to come back after the MRI is because Kinley will have to be sedated for the MRI and then she can work on removing more sutures without Kinley moving around.
Due to Kinley's earlier kicking and flailing, she is now without an art line. The art line was in Kinley's left foot, but she kicked it out entirely. The art line was used to draw blood for her blood gas tests and monitor her blood pressure. Now that Kinley is without an art line she will need be poked every time to draw blood whenever they need to do a blood gas test and the only way we will know her blood pressure is if they put a blood pressure cuff on her. The blood pressure cuff is the exact same as the one at your doctor's office, it is simply smaller. Not having constant blood pressure readings will probably be hardest on me since I tend to focus on her screen of stats, but at least I know that her blood pressure has been really constant since coming off of ECMO.
Good news! Brecklyn has received word that Kinley's MRI might be moved up to 11:30 am. Originally Kinley's MRI was scheduled for 4:00 pm. All we can do now is keep our fingers crossed that the 11:30 am slot stays open.
We made it in time for rounds today. Dr. K was planning on decreasing Kinley's versed (sedative) drip a little bit, but since she will hopefully be going to MRI today he decides not to make any changes because she will need the sedation during her MRI. Before Kinley can be extubated (breathing tube taken out) Dr. K wants her to have her head MRI and have her chest tube clamped for 24 hours. Since Kinley's chest tube was clamped this morning, Dr. K will take a close look at tomorrow's chest x-ray and make a determination then of if Kinley is ready to be extubated. Back when Kinley's original PICC line looked irritated they took a blood sample to check and see if she had an infection. While they waited for results they started Kinley on some antibiotics. Dr. K has decided to stop those antibiotics because the blood sample is showing no signs of an infection. But a recent tracheal aspirate (test of lung secretions) is showing a possible infection so they will begin a different antibiotic today.
Kinley left for her MRI around 11:45 am. It should take between one and two hours depending on what they see and how well they can keep Kinley sedated. She needs to remain very still during the MRI, but she is known for burning through her sedation very quickly. Remember this morning, Brecklyn gave Kinley an extra dose of both morphine and versed and it didn't even slow her down.
Wednesday, July 2, 2008
Tuesday, July 1, 2008
Tuesday, July 1st - It's Daddy's Turn
Before we get to daddy's big day we need to take care of some business first. This will not take long as there are not to many changes to Kinley's care plan today. Basically, when I (Kathy) arrived Katie informed me that the plan for today is to let Kinley rest a little. She will have her versed decreased from 150 to 135, but that is pretty much it for now. Kinley did really well last night and didn't need any extra doses of morphine or versed (PRN's as we medical folk like to call them). She is still getting blood gas tests, but now they will be every 8 hours instead of every 6 hours. The blood gas results have all been really good, but since Kinley is on such low vent settings already there is not really much more to wean, so the vent settings are staying the same. We are now just waiting for two things. The first is for Kinley to go to radiology for the MRI of her head. The second is for her chest tube to be removed, but surgery wants to wait until its output is a little less. Once both of those are done then hopefully she can be extubated (take the breathing tube out of her mouth and get rid of that pesky vent)! Hopefully Kinley will get to have her MRI tomorrow, but she is not scheduled until 4:00pm so there is probably a good chance she might get bumped to Thursday. Lets hope not though.
Today was a big day for daddy. First of all, he went back to work for the first time since Kinley was born, but with his new part time schedule he was able to get off at noon and be at the hospital by 12:40 pm. It is so nice that Kevin's work has been so accommodating for Kevin and I. It has really helped us out with Kinley being at Children's Mercy and it will be a huge help when Kinley comes home. Thank you. We really appreciate it.
Now for the other part of Kevin's big day...he was finally able to hold Kinley for the first time! Once again Kinley did really well with the transfer from her bed and fell fast asleep shortly after being placed in her daddy's arms.
Katie placing Kinley in daddy's arms.
Katie & Lindsay (respiratory therapist) get Kinley organized.
Kinley has come a long way, but she still has plenty of tubes and wires.
In daddy's arms at last.
He is such a natural daddy.
Kinley is already fast asleep.
I can't decide who is better looking?
The Melcher Family (if only Kobi, our dog, could be here)
Today was a big day for daddy. First of all, he went back to work for the first time since Kinley was born, but with his new part time schedule he was able to get off at noon and be at the hospital by 12:40 pm. It is so nice that Kevin's work has been so accommodating for Kevin and I. It has really helped us out with Kinley being at Children's Mercy and it will be a huge help when Kinley comes home. Thank you. We really appreciate it.
Now for the other part of Kevin's big day...he was finally able to hold Kinley for the first time! Once again Kinley did really well with the transfer from her bed and fell fast asleep shortly after being placed in her daddy's arms.
Katie placing Kinley in daddy's arms.
Katie & Lindsay (respiratory therapist) get Kinley organized.
Kinley has come a long way, but she still has plenty of tubes and wires.
In daddy's arms at last.
He is such a natural daddy.
Kinley is already fast asleep.
I can't decide who is better looking?
The Melcher Family (if only Kobi, our dog, could be here)
Monday, June 30, 2008
Monday, June 30th - Mommy's First Hold
Kinley is 36 days old today and it is the first time that Kathy has been able to hold her. They are a perfect couple. My two beautiful ladies. Kinley fell asleep almost immediately after being set in her mommy's arms and she remained there, fast asleep, for 3 hours. FYI - it did take two highly trained nurses to move Kinley (with her tubes and wires and ventilator) from her bed and into mommy's arms. Here are some pics of mommy's first hold.
The transfer to mom by Katie and Sarah
What's going on here? This isn't my bed!
Sure is comfortable though. I'm getting a little sleepy.
Going. . .
Going. . .
Gone. (Oh yeah, GO WILDCATS!!!)
The Melcher Family. Together at last.
Still sleeping.
Kinley's belly button finally fell out the other day.
Back in her old bed.
Kinley was so happy and content in her mommy's arms today that I didn't want to disturb here. Maybe tomorrow I will get my chance to hold my baby girl.
The transfer to mom by Katie and Sarah
What's going on here? This isn't my bed!
Sure is comfortable though. I'm getting a little sleepy.
Going. . .
Going. . .
Gone. (Oh yeah, GO WILDCATS!!!)
The Melcher Family. Together at last.
Still sleeping.
Kinley's belly button finally fell out the other day.
Back in her old bed.
Kinley was so happy and content in her mommy's arms today that I didn't want to disturb here. Maybe tomorrow I will get my chance to hold my baby girl.
Breathing Room Air (if only for a little while)
Just a really quick note because I am not sure how long it will last, but Kinley's vent is only providing her with 21% oxygen. That is the same as if she was breathing "room air." Hopefully she can maintain her blood oxygen saturation levels in the mid 90s.
That was short lived, but at least we know that Kinley is close. Katie had to turn the vent back up a bit because Kinley's blood oxygen saturation went down to the high 80s. Kinley was able to maintain the high 80s, but the doctors want her in the mid to high 90s. It looks like Kinley will be dancing around the 21% "room air" mark. She is currently at 23% from the vent and she is sating in the mid 90s. It is funny to see what a difference 2% can make.
That was short lived, but at least we know that Kinley is close. Katie had to turn the vent back up a bit because Kinley's blood oxygen saturation went down to the high 80s. Kinley was able to maintain the high 80s, but the doctors want her in the mid to high 90s. It looks like Kinley will be dancing around the 21% "room air" mark. She is currently at 23% from the vent and she is sating in the mid 90s. It is funny to see what a difference 2% can make.
Monday, June 30th - Lots of News
Kinley's trip to radiology and the placement of her new PICC line went great. She slept through the entire procedure. Her new PICC line is in her left arm and enters the vein right around the elbow. Dr. K has decided to keep Kinley's art line in place, but not sure how long he will want to keep it in because they can now draw blood from Kinley's new PICC line.
Katie is back today to take care of Kinley and she give us an update on all of the BIG news that we missed from rounds.
1) Versed Drip: Now that Kinley has been completely off of her morphine drip for a few days it is time to start weaning her versed (sedative) drip. Today they will lower it from its current rate of 180 to 160. They may also begin the replacement drug for versed, which is ativan, but it is not for sure yet.
2) Head MRI: Kinley is scheduled for a MRI of her head on Thursday. Every baby that has been on ECMO has to receive a head MRI. This is to check and see that all portions of the brain are having good blood flow. Remember, ECMO increases the risk of brain bleeds and clots.
3) Extubation: Kinley has been doing so well on the conventional ventilator that they may remove her breathing tube on Friday and then she will be ventilator free.
Drumroll please!
4) Best News of the Day: We may be able to hold Kinley today. This would be the very first time that we have been able to hold her since she was born 36 days ago.
Katie is back today to take care of Kinley and she give us an update on all of the BIG news that we missed from rounds.
1) Versed Drip: Now that Kinley has been completely off of her morphine drip for a few days it is time to start weaning her versed (sedative) drip. Today they will lower it from its current rate of 180 to 160. They may also begin the replacement drug for versed, which is ativan, but it is not for sure yet.
2) Head MRI: Kinley is scheduled for a MRI of her head on Thursday. Every baby that has been on ECMO has to receive a head MRI. This is to check and see that all portions of the brain are having good blood flow. Remember, ECMO increases the risk of brain bleeds and clots.
3) Extubation: Kinley has been doing so well on the conventional ventilator that they may remove her breathing tube on Friday and then she will be ventilator free.
Drumroll please!
4) Best News of the Day: We may be able to hold Kinley today. This would be the very first time that we have been able to hold her since she was born 36 days ago.
Sunday, June 29, 2008
Sunday, June 29th - PICC Your Trip! (The Game Show)
Announcer: Hello everyone and welcome to a brand new episode of "PICC Your Trip!" The game show where contestants choose what to do about their vein irritating PICC lines. Today's lucky contestant is Kinley Melcher. Kinley was born with a congenital diaphragmatic hernia (CDH) on May 25th and has spent most of her life on ECMO (heart and lung bypass) while vacationing within the friendly confines of Children's Mercy's NICU. But now that Kinley has had her CDH repair surgery and come off of ECMO she is enjoying the life style, that we all know and love, of recovery and IVs. One IV in particular, the PICC line, is why Kinley is here today. Welcome Kinley and thanks for being on our show!
Kinley: Thanks for having me. Ow. I am so glad to be here. Oww!
Announcer: I see that you are in pain. Can you tell us what is going on?
Kinley: Sure. (grimace) I have a PICC line running up my right leg and it has irritated and inflamed the vein it is running through. Now I need to have it removed and a new one put in because it is used to supply me with all of my nutrition until I can eat for myself. But the problem with putting in a new one is that most of my limbs are already taken up with other IVs. The only places left to place a new PICC line are my left arm and the left side of my head. The right side of my head won't work because that is the same region where my ECMO tubes were in.
Announcer: Wow! Has anyone tried to put in a new PICC line yet?
Kinley: Yes. Brian, one of my previous ECMO nurses, has tried to place a new PICC line in my left arm, but my veins just weren't cooperating. I cried and screamed the whole time, mainly because I am currently going through morphine withdrawals. Not even extra doses of morphine and versed could calm me down. It is a good thing I was intubated because I would have woken up the entire nursery. It was also a good thing that my dad didn't take any pictures of me upset because I would have had to hurt him.
Announcer: That's too bad that it didn't take. Well, have you at least had the PICC line removed from your leg?
Kinley: Yes. It may have been just as painful as trying to get my new PICC line in. Initially, my old PICC line was coming out smoothly until my irritated and inflamed vein spasmed and clamped down on the line, making it near impossible to remove. The nurses had to bring in heat packs and wet wipes to help my vein relax. After about a half an hour of hard work by the nurses, and me silently screaming my head off, the old PICC line was out.
Announcer: Alright Kinley, I can see that you are in A LOT of pain.
Kinley: You're "bleep"ing right I am in pain! Today was supposed to be a relaxing day, but my veins aren't "bleep"ing cooperating and I have spent most my day "bleep"ing screaming and crying!!!
Announcer (off camera): Alert the nurses and security! We may lose control of this one. (A nurse brings the announcer a hand written note.)
Kinley: Sorry about that. I am just having a rough day.
Announcer: That's quite alright. I have just been informed that we can only offer you one trip on today's show, instead of the typical three we normally do. Apparently the doctors and nurses feel that it would be against your best interests, and health, to go to London or Cabo San Lucas in your current state. So we will only offer you the third and final trip. Are you ready?
Kinley: Yes, although it would have been nice to go to Cabo and work on my tan. But I am pretty sure that my ventilator wouldn't fit in the airplane's overhead compartment.
Announcer: Kinley Melcher, you are the proud winner of an all expense paid round trip to Children's Mercy Radiology department. Tomorrow morning you, and your ventilator, will be rolled down to Radiology. There you will be pampered and spoiled with the finest of sedatives. And while you are sedated the radiologist will place a new PICC line using an ultrasound machine to guide his movements. After the placement of your new PICC line you will be returned to your little slice of heaven known as bed station D-39. How does that sound?
Kinley: That sounds perfect. I better rest up for my trip. I wonder what I should wear? Got it! A diaper.
Kinley resting up for her trip to Radiology tomorrow
Kinley resting while her dad works on corny blog posts
Kinley: Thanks for having me. Ow. I am so glad to be here. Oww!
Announcer: I see that you are in pain. Can you tell us what is going on?
Kinley: Sure. (grimace) I have a PICC line running up my right leg and it has irritated and inflamed the vein it is running through. Now I need to have it removed and a new one put in because it is used to supply me with all of my nutrition until I can eat for myself. But the problem with putting in a new one is that most of my limbs are already taken up with other IVs. The only places left to place a new PICC line are my left arm and the left side of my head. The right side of my head won't work because that is the same region where my ECMO tubes were in.
Announcer: Wow! Has anyone tried to put in a new PICC line yet?
Kinley: Yes. Brian, one of my previous ECMO nurses, has tried to place a new PICC line in my left arm, but my veins just weren't cooperating. I cried and screamed the whole time, mainly because I am currently going through morphine withdrawals. Not even extra doses of morphine and versed could calm me down. It is a good thing I was intubated because I would have woken up the entire nursery. It was also a good thing that my dad didn't take any pictures of me upset because I would have had to hurt him.
Announcer: That's too bad that it didn't take. Well, have you at least had the PICC line removed from your leg?
Kinley: Yes. It may have been just as painful as trying to get my new PICC line in. Initially, my old PICC line was coming out smoothly until my irritated and inflamed vein spasmed and clamped down on the line, making it near impossible to remove. The nurses had to bring in heat packs and wet wipes to help my vein relax. After about a half an hour of hard work by the nurses, and me silently screaming my head off, the old PICC line was out.
Announcer: Alright Kinley, I can see that you are in A LOT of pain.
Kinley: You're "bleep"ing right I am in pain! Today was supposed to be a relaxing day, but my veins aren't "bleep"ing cooperating and I have spent most my day "bleep"ing screaming and crying!!!
Announcer (off camera): Alert the nurses and security! We may lose control of this one. (A nurse brings the announcer a hand written note.)
Kinley: Sorry about that. I am just having a rough day.
Announcer: That's quite alright. I have just been informed that we can only offer you one trip on today's show, instead of the typical three we normally do. Apparently the doctors and nurses feel that it would be against your best interests, and health, to go to London or Cabo San Lucas in your current state. So we will only offer you the third and final trip. Are you ready?
Kinley: Yes, although it would have been nice to go to Cabo and work on my tan. But I am pretty sure that my ventilator wouldn't fit in the airplane's overhead compartment.
Announcer: Kinley Melcher, you are the proud winner of an all expense paid round trip to Children's Mercy Radiology department. Tomorrow morning you, and your ventilator, will be rolled down to Radiology. There you will be pampered and spoiled with the finest of sedatives. And while you are sedated the radiologist will place a new PICC line using an ultrasound machine to guide his movements. After the placement of your new PICC line you will be returned to your little slice of heaven known as bed station D-39. How does that sound?
Kinley: That sounds perfect. I better rest up for my trip. I wonder what I should wear? Got it! A diaper.
Kinley resting up for her trip to Radiology tomorrow
Kinley resting while her dad works on corny blog posts
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.
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.
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