Friday, June 3, 2016
Ezekiel has continued to make slow progress over the last few days. We've had some minor hiccups, but overall he's been doing well. He's currently on ventilator settings of: pressure 24/6, rate 20, and O2 of 43%.
Yesterday he continued to have his desat spells so the doctors wanted to try a couple things to try and fix those. They took a blood sample to test his BNP level which was 360. Normal range is closer to 100. BNP is an indicator of heart/lung issues and due to it being elevated they went back up on his nitric to 10 ppm. He seems to be having fewer and less severe desats since they did that. They also wanted to start weaning his fentanyl since he's been on it for almost 2 months now. In order to do that they've started to transition him to methadone to make the weaning easier. He got his first doses yesterday and he's done well with it.
This morning they took an echo of his heart and it looked good. They wanted to take a look at his heart and check how filled the vessels in the heart were. That drives whether he has the vascular fill to justify taking more fluid off. The renal doctor said that they were slightly overfilled so they can start being more aggressive with his dialysis. Since the pressure in his dialysis lines have gone up and he's had bleeding at the insertion site (happened again today) they also confirmed that there weren't any blood clots in his heart (which there weren't).
This morning after the echo around 0830, they had an issue with him bleeding from his vascath again. They got the bleeding to stop and redressed the site. This time they also placed surgiseal (essentially a cloth mesh) over the insertion site to promote clotting if he starts bleeding again. They left him off the dialysis pump and turned off his heparin to ensure that he wouldn't start bleeding again. They put him back on the dialysis pump at 1530 with no issue.