Today was an uncomfortable day. I called the NICU this morning and talked with Lisa G., his primary who hasn't been around for a few weeks. They hadn't yet tried to put a PIC line into Henry. She mentioned that if they couldn't put in a PIC line, then they might have to consider surgery.
When I arrived in the NICU, a father was bringing a three year old into the NICU. They washed their hands for a total of 20 seconds. Then, another father, who I hadn't seen before, said to me "Wow. Do you really wash for the whole 3 minutes?" as I continued to wash my hands. I said that of course I did. I explained how CDC research states that you need to wash that long to get rid of the bacteria on your skin and how bacteria can kill babies. I mentioned that even if you don't touch your baby, you touch other items in the NICU that other people touch. So it was important for everyone to wash for the entire time. He seemed surprised at this information. I think that I got him to wash his hands longer.
When I arrived at Henry's bedside, the residents were still in rounds, so nothing had changed. Henry's respiration was very high. Lisa G. said that he was probably upset from his morning eye check. His eyes look fine for his gestation. No problems yet. Henry couldn't seem to get comfortable.
After they finished rounds, his resident doctor, Dr. Jeminah Van Handel, said that they would be increasing his feeds by .5 ml/hour with the increases taking place every twelve hours. So he's now at 1.5 ml per hour. If all goes well, that would make him at 6 ml per hour (his goal) by the end of the week. I forgot to mention that Jeminah left us cupcakes yesterday to celebrate his reaching 1,000 grams. Very nice of her.
NP Lisa McCoskey took a look at Henry to see if she could spot any potential veins for PIC lines. She found some candidates. NP Andrea Saugstad was the one who put in the PIC. She said he had good veins (at least for placing lines in him; the veins must be fragile b/c his PIC lines don't last long). By this time, it was around 2:30PM. Took a while to set up for the procedure. Lisa G. gave Henry some sucrose for the pain. On Andrea's first try, she went into a vein that had a good return (meaning the blood was flowing) but the line wouldn't thread up the canal. On her second try, she started further up that same vein (to by-pass the areas that it wouldn't thread) but the vein didn't give her a good return. Finally, she went to another vein that was large, but it was more complicated because it runs around the back of the arm. The vein had a good return, and she managed to get it threaded. An x-ray was taken, and its placement looked OK. Henry tolerated the procedure well.
Jeff arrived after his work, just in time for cares. Somehow, he managed to get my mom to help me change the diaper instead of him. The first diaper was 61 grams! Henry, as you can probably guess, had been given his 1 ml dose of Lasix a few hours earlier. Once the diaper had been changed, Henry made a mess of it within seconds. Grandma did the dirty work on diaper number two and changed it like a pro.
Henry's respiration was still very high. His chest was moving in and out rapidly. Lisa G. thought it was a combination of him having a busy day (eye exam and PIC line) and him needing to produce a stool to get the bowels working. I went home to get some household chores done while Jeff watched over Henry. He said that Henry's respiration went down to more appropriate levels. He decided not to kangaroo today, since Henry seemed worn out and needed quiet time.
I went back around 9PM. In the washroom, I saw a man that I had talked to earlier today about handwashing. I ascertained that he is the father of Henry's Pod One girlfriend, the 23.5-weeker. Despite there being 28 babies in the NICU today, it wasn't a difficult match to make. I'm guessing that about 75% of the last names are of Hispanic origin. The father is Asian-American, and Henry's girlfriend has the only Asian-American last name on the board. I still don't know the first name of Henry's girlfriend. Her father said that she is doing OK. She's been there two weeks and pulled out her ventillator tube (so she and Henry already have something in common).
Melissa J., his primary, was on duty. She had just finished with his cares when I got there. His diaper was 38 grams. It wasn't particularly surprising that his weight was down to 1,020 grams. She ended up taking out the peripheral IV that was in his foot because she wasn't able to flush it. Hopefully, the PIC line will continued to work.
I asked her if she could look at the records to see how many PIC lines Henry has had (the official count). There isn't a log of the PIC lines exactly, but she was able to see how many times he had had x-rays for PIC lines. There is one entry from a while back that reports an x-ray for PIC line in his left arm and then 45 minutes later reports another x-ray for a PIC line in his right arm. It's unclear whether that was really two PIC lines or whehter it was one that had to be taken twice based on a not great placement the first time around. I'd assume it was the same line. If you take that as the count, he has had 7 PIC lines, which is a lot. I pray that this recent one lasts. He's still too little for surgery.
Melissa asked me if I wanted to do kangaroo care tonight. I said that I would hold off since Henry had had a stressful day. She said that he'd been doing well and he likes the skin-to-skin. I still declined. Someone in Pod Three was screaming their head off. It was so loud. I'm glad that Henry's not in that pod. It sounded like mass chaos in there. Then, Nathan's father (Nathan is one of the babies in Pod Four; he's the baby with the amazing head of hair that was so long, his grandmother came and gave him a haircut) was loud. Kangaroo care is excellent when it is peaceful; but when it is loud, it stresses me and Henry out. In the end, I lowered the isolette and placed my hands on Henry's head and feet so he knew I was there. Henry's new corner of the world is much less hectic than other areas of the NICU. Hopefully, tomorrow will be a quiet day, and we'll resume skin-to-skin.
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