Saturday, September 29, 2007

Saturday Morning Update

Oh what a night...If you haven't read Friday's post, you may want to start there (below) and than come back to read this one.

Trish's Hickmann was replaced with a Hickman Pheresis catheter yesterday. This catheter is larger than the regular Hickman in terms of tube circumference and it ends directly in Trish's heart (right atrium) instead of in the vein leading to the right atrium (not really sure why).

The IPOP nurse changed the dressing at about 6pm Friday and gave me what she thought would be plenty of supplies to change it over the weekend.

At 10:00pm, I changed Trish's dressing and called the CVDL on-call doctor because the gauze had become saturated and she was still leaking. He told us to place a weight on the site and have Trish sit up at a 45 degree angle. In the hospital they usually use a liter bag of saline for weight, we used a phone book.

At about 3am, Trish woke up to go to the bathroom and her chest and side and bed were covered in blood. I paged the IPOP on-call attending and instead of changing the dressing added gauze to absorb the leaking blood and wrapped towels around Trish's chest. The IPOP doctor said that there was probably no eminent danger and that we could either go to the ER or wait till 7am to go to IPOP. Having experienced Hopkins ER before, we chose to try and sleep for a few hours and than head to IPOP. We were the first people in IPOP this morning, even beating the nurses in.

They changed her dressing, took her blood, put a cold compress on the area and weighted it with a bag of saline. Her platelet counts was at 66 only down 2 from yesterday and still 16 above the minimum required for line placement. Her hematacrit held to yesterday's number of 27.8 (it likely would have been higher if she hadn't lost any blood). It's about 10am now and Trish just finished receiving a bag of platelets and will get a unit of red as well.

If they get the bleeding under control, we will try to head up to Aunt Mary's house, spending the night there before heading back Sunday night. As long as they get this under control, she is still green lighted to start ECP Monday.

Two other significant things.... I forgot to report yesterday, that for the first time in a while, Trish gained weight -- only a half pound, but it is going up. Today, her billirubin went down, not by a significant amount, but it went down....the other liver enzymes also went down from yesterday and they appear to be continuing a good trend.

No comments: