NICU Night #74 - Positive Thinking

Saturday, July 3, 2010

We had a late night getting home from the July 4 celebrations in St. David so I walked into Timmy's room at 11pm.  I hate going in that late because I fear being too tired to get to hold him for very long, but it worked out well again tonight.

Jenny had Timmy again.  The minute I walked over to him, she was at my side because he desatted into the 60s and 70s.  Following the first suctioning, he bradyed down to 55, bouncing quickly up into the 80s, but it took a little bit to get him back into his 140s/150s.  Most likely this was a vagal response from being suctioned. However, his oxygen saturation hung out in the 70s for a while in spite of repeated suctioning.  He persistently sounded crackly.  Melissa was also on and came from next door to visit after about the fourth suctioning from Jenny and also gave Timmy a suctioning.  It was unanimously agreed that Timmy's tube was loose and that might have been what was causing the desatting.  Lori, one of the most entertaining respiratory therapists and all around nicest people I have ever met, had Timmy tonight too so she and Melissa retaped Timmy's ET tube and it did help.

During the taping, Dr. Bedrick came in and asked how things were going.  I told him that Timmy seemed to be having a lot more secretions and asked if Dr. Parry has any colleagues who might be able to extubate Timmy.  Dr. Bedrick said that Dr. Parry is the only pediatric ENT in town and, since he already said he wants to leave Timmy intubated until he gets back from vacation, we should "respect" that.  Truly, if he is the best (as I've heard he is) and we could possibly encounter further delays by trying to rush with someone else, I will do my best to patiently wait yet another week.  Dr. Bedrick is going to call, though, and check regarding the secretions.  Dr. Parry had made it sound fairly urgent that we get the tube out as soon as possible.  I did ask Dr. Bedrick if we could possibly get Timmy on his schedule for the first available on Monday.  Agreed.

I had Timmy in my arms around 11:40.  Definitely getting a late start but always worth it.  We kangarooed tonight for the first time in 10+ days.  So nice to get to kiss his sweet soft little head again.  (A piece of the ET tube tape had somehow gotten stuck to the back of Timmy's head.  One end didn't want to let go so I had to ease it off with a Saliwipe while Melissa was holding him in the process of moving him to me.  Always a tender moment when you get to be the one to love on your baby and calm him down.)  Melissa brought me the book "Harold and the Purple Crayon" to borrow and read it to Timmy and me.  It's sooo cute!  Fabulous read for little ones!  We will definitely be getting our own copy.

Lori Dunckle came in to visit shortly after Melissa left.  Great to get to see her again too.  She and Jenny and I chatted about kids breaking bones and what it must be like being an ER doc.  She has a son who has broken both arms (on the monkey bars both times) and one visit was a late one and she was a bit concerned about one of the other patients.  You never know what you are going to get with night owls.  I can only imagine that that must keep anyone on their toes constantly and never a dull moment.  No patient lists to go off of, you never know what you're going to get.

Cindy came in to visit too.  She was actually the up for the night, saying that she thinks once Timmy gets the tube out, he won't have any trouble feeding and he'll be out the door.  He has such a strong suck and an affinity for working his tongue.  I'm hopeful.  I do understand that just because someone says something positive doesn't mean that's the way it's going to be.  (We all originally thought Timmy would go home early but it is officially his due date as I write this and we will not be bringing Timmy home tomorrow.)  But it does make a difference in the way I feel about the whole situation and my ability to think positive again and not dwell so much on the extension of time on the ventilator.

Missing Laurel.  She is Timmy's only nighttime primary that I didn't get to see tonight.  Hoping that all is going well for her and that she will feel better soon and we will get to see her again.

Timmy's weight tonight was 2.67kg (5 lbs. 14 oz.).  The missing weight from Thursday night ended up being 2.33kg (5 lbs. 2 oz.).  Somehow having Friday night's weight be up almost a full pound from that seems a bit of a stretch.  A wet diaper or a bowel movement in process can make a difference, but a pound seems a bit much.

I also didn't get a lot of pictures tonight.  A few on my cell phone (yes, they are allowed in Timmy's room now.  Haven't seen any signs in the new unit, so the ban may have been lifted altogether) but James had taken the camera during the fireworks to capture the kids' expressions and I forgot to put it back in my purse before heading out.

Just another sweet evening.

Vent settings the same as last night with the exception that flow rate is now at 10.  Wahoo!!!  I don't know if they'll drop him any more.  He's now where he was the last time they tried to extubate.  I think Timmy will just sit on the current settings until Dr. Parry can get him off next week.