Thursday, May 21, 2009

A central line is reallly no big deal. Except it is.

Out-patient line placement is not fun.  Gregory's first line was placed while we were in-patient and we had constant care and no reason to take him anywhere.  We arrived at Seattle Children's at 8:15, left at 3:15 and were home at 4:30.  It was long, but it went amazingly quick.  Niki, you are so right about this time flying. 

Here's the details on the placement of his Hickman :  Rather than try and "re-wire" Gregory's existing line, they placed an entirly new line.  Using the existing site, means a risk of infection.  Any risk of infection is a no-go in my book and I'm really glad the surgeon saw it that way, too. Despite the results.  They are not bad, just much more complicated than the could have been.  When a central line is place, they use what they call 'cuffs' at the exit site.  These act as an anchor and the surrounding skin grows into the cuff, allowing the line to stay in place.  They removed the cuff and went to pull the line out and met resistance.  About four inches up the line, that is tunneled under his skin, there was a second cuff.  In order to remove the first line, they had to make a very small incision above the cuff and go get it.  At this point, they were able to removed the line.  So.  If you are counting holes, he has a healed hole at his right side neck, where the line was originally threaded through.  A hole where the line came out and a hole where the second cuff had to be removed.  Now.  Time for the new line.  The entry spot for this line is on the left side of his neck.  It was tunneled, threaded around the heart, into a vein and it exits between his left nipple and his arm pit.  Two more holes.  His original line exited about mid chest.  The current exit spot is where they are mostly placed.  At least over here.  I can't speak for Spokane.  (Jess, where does Ellie's exit?  Just curious.)  He now has a line with two "tubies"  pronounced toobies.  I really hate this word.  Why can't they be called by there real name?  I need to find out what they are called and start using it.  I do not like dumbing down language for kids.  Especially as it relates to their body.  I digress.  Once they had the new line place, it wouldn't draw properly.  It was intermitent.  Which is NOT  a good thing.  When it was placed deeper, it ran perfect.  I'm not sure what the long term result of a deeper placed line is.  I'm going to ask tomorrow.  Needless to say, the procedure took longer than anticipated.  So did his recovery.  It just took a little longer for him to be OK to come out to me.  As part of the placement, they also take a post x-ray to verify a good placement of the line.  I really need to start keeping track of these things.  It all equals a bead!  More on that, another time.

All this time, I've been anxiously awaiting his arrival.  Nervously trying to distract myself with reading.  Not doing a very good job.  He finally gets wheeled in and here is this precious little nymph, sitting up, naked except for a diaper and calm as can be.  Looking like he'd been wrung out.  The nurse who brought him back just could not say enough about how well he cooperated, went with the flow and how perfectly precious he was.  She actually started choking up about it.  'Cause it's kinda bitter sweet, how well Gregory just goes with the flow.  He's become a pro at stuff like this and I imagine that he anticipates each step, helping out along the way.  That's just how he is. 

They use intibation, with their general anesthesia.  So Gregory was tubed for this procedure.  He has never had that happen before.  I can see where the tube was taped down and they also taped his eyes shut.  He has blotchy skin and petechia where the tape was removed.  As we were waiting to be called back, it dawned on me that they would need to poke him.  They could not use his line, if they were replacing it.  Thankfully, they didn't place the IV until after he was out.  He also did not say a thing about having an IV.  When his line was originally placed, he could not wait to have the IV removed.  It was in his hand with a board securely taped to his hand.  When they removed it he aggressively helped the nurse to removed all the tape and dressings.  Once it was out, he looked up at the nurse, very sternly, pointed his finger at her and shook it with each word saying, "No... More...Pokes!"  I was worried that he would react badly to having an IV today.  Thankfully it was a non-issue. 

I also managed to get him to wear the hospital gown and a diaper.  Huge accomplishment.  Granted, the diaper was on OVER his underwear.  I didn't care.  I just didn't want him sitting in wet sheets. 

Once we were together, again, we cuddled for about an hour, he drank a juice and we were free to leave.  Except for the pain meds.  It is crucial that we know if Gregory has a fever.  Pain meds with fever reducers are not an option, for us.  The doc prescibed Liquid Oxy and the pharmacy at the hospital did not have any.  Crap.  We went to Bartell's at University Village (I called ahead to verify that they had it!) and had it filled.  We made it home and relaxed, together. 

I am learning how to pick him up.  Due to the exit being so close to the arm pit, I can't pick him up, under the shoulders.  Which really sucks.  We are doing a modified under-the-left-shoulder-right-side-botto
m/knee-scoop.  It looks and feels really akward.  He must also have some throat irritation.  He started to get a little froggy before bed and has been wheezing.  I'm hoping it is because of the intibation.  Another thing to check on, tomorrow. 

Curtis and AnnMare are coming home tomorrow from camp out.  Three days and two nights with their classmated, in the wilderness.  It is the coolest experience, ever.  I hope everyone had a great time and has some pix to share.  Please?  Sandra, thanks for sending a few of AnnMarie, you are so good at looking out for her.  You always have.  When I received tonight's pic, I was like "Skit night, already?'.

AnnMarie's sweater is "finished".  I now need to seem the arm pit holes and secure all the lose ends.  Sssshhhhh.  Dont' tell her, K? 

Alright.  I'm wraping up this entry and I'm going to go and do something else.  Not sure what, yet.  I'm a little fried.  'til later, gotta jet.

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