Oct 9, 2012

Hemostat anyone?

Going to tell this story as quickly and succinctly as I can. 

This afternoon at 4pm they put in the Ethanol lock like usual.  At 8pm Manny was sleepy and falling asleep in my arms but I was trying to keep him awake with tickling him. But alas, he fell asleep. They came in to withdraw the ethanol.  It came out.  Blood came out.  Perfect.  Then she went to flush it and he said, "Ow, wet".  Something had "leaked" on his tummy and it woke him up. 

We thought the syringe wasn't screwed on right so she reapplied it.  Squirt.  Saline everywhere but couldn't tell where it was coming. She went to go get another syringe and we watched it slowly go in and water poured out from under his dressing.  That meant there was a break/leak somewhere in the line. 

I looked at the clock and noticed it 8:15 and suggested she go call the IV team ASAP.  I'd just seen Mani in the hallway about 2 hours earlier.  I know they leave about 9pm. 

I was sitting in shock.  Depending on where the break is ... this can be an "easy" repair.  Or this could mean that he needs a whole new line.  That is BAD news. 

The RT was there the whole time during this and we knew we had to do that breathing treatment now.  It will be the only one he gets through the night so we need it.  (Why? the sleep study, they don't want it interruped).  So I put Manny on the bed and she started the treatment which of course woke him up. 

I walked to the open door and nurses/techs were gathered around seeing what was going on so I told them.  I was there like 1 minute.  Then walked back to Manny.  When I did I noticed a huge stain of blood on the front of his shirt.  I immediately pulled up his shirt and it was spurting blood. 

You see, this line is placed right near the Superior Vena Cava (SVC) which is a vein right near the heart.  And while this is still a vein, because it's right there, it acts more like an artery.  I yell out the door. 

The charge nurse and nurse came running.  They knew they needed a hemostat (a type of clamp) and they came back with metal ones and no gauze.  I quickly remembered what Stephanie from the IV team taught me ... must be a plastic hemostat and there must be gauze or the line will be further injured.  They couldn't find one quickly so I grabbed my purse and pulled mine out.  I had gauze and the hemostat handy. 

All this took place in a matter of a minute or so.  The nurse clamped it.  That serves to make the blood stop spurting and air to not go into the line and create an air embolism. 

(There's a nurse near the door by now that I don't know ... I'll have to figure out who she is.  She was telling everyone that protocol is that every room with a kid with a central line should have a hemostat with gauze hanging in it.  That's the way they do it in the ICU.  I told her I've NEVER had a hemostat in my room, on the floor or in ICU but I know I would make sure that is done from here on.  I also suggested that this incident be the reason for the process to be evaluated for the future.)

 We clean him up.  Crisis stayed.  Mani comes in and we see where the break is.  Thankfully it's in a spot where it can be repaired!  That took only about 30 minutes.  My blood pressure started to come down.  Repair done.  Then another dressing change.  Manny was a trooper.  He was scared at first but then calmed down. 

Did I tell you he calls it his "fire hose" and pretends to squirt water with it when it's not connected to an IV?  I told him his fire hose broke and Mani was going to fix it.  He understood. 

OK so next problem.  You know how his blood sugars drop QUICKLY?  And you remember how I just said we were in the process of taking the ethanol out when it broke?  Well that means he had been off fluids for 4 hours and was going to need to get back on ASAP.  Problem?  Can't use a line for 4 hours after a repair!  There is no stinkin way he could wait 8 hours for fluids.  So we realized we would have to do an IV. 

Thankfully, Mani was able to get it on the very first stick like it was nothing.  She keeps telling me not to get spoiled.  Ha!  Too late. 

By then it was 9:30 and the guy arrived for the sleep study.  We're only doing the 7 channel ... not as much "stuff" as what we're used to all over his head and face.  (That's probably good news considering how traumatic this night already is.) 

He got it all set up and Manny fell asleep.  10pm

Me?  Trying to shake the whole thing! 

This was scary.  And I imagined what would have happened if I had been at home or away.  And truthfully I could have done it ... clearly.  I had the tools and knew how to use them.  I knew what needed to be done (Thanks Stephanie for the training!!).  So in that moment I could do what I needed to.  (God seems to prepare me for stuff so I try to pay attention as I go.  I know there will be a use of the info somewhere along the line.)  But if I'd been away from the hospital, the whole drive there and wait would have freaked me out a bit.  As it was, we were in the best place at the best time!  An hour later and the IV team would have been gone. 

God is good and is always looking out for me!  Thanks for the prayers!!

I told the nurse that she did a great job and thanked her for her help.  She teared up.  She was visibly still shaken from the event.  I told her that my life is full of moments just like this.  That THIS is what my life is like.  And she looked at me in horror.  And I told her that she did great in my world. 

Now on to the sleep study ... sadly, I'm hoping he has trouble breathing tonight.  What a strange thing to hope for I know.  But I just want them to "catch" what it is that he's been doing lately that's freaking me out at home.

Night all.

1 comment:

  1. Yike Beth..... I want it to stop! I want Manny to stabalize for a good long time. Thank you for keeping us posted. Sending you love.