Tuesday, July 19, 2016

July 19, 2016

Ezekiel continued to have some issues with his vascath this last week, but the doctors finally got it resolved. Since then he had some pump issues and BP fluctuations, but he’s been fine otherwise.
Last Sunday (10JUL) he continued to have issues with his vascath. They ended up leaving him off the pump until monday morning. When they tried to put him back on dialysis, he started bleeding again. The docs decided to conduct a contrast study to see how everything was flowing through the vessel. Sometimes the blood vessels become inflamed and constricted after having the catheter in for a long time. Tuesday morning they performed the contrast study and there were no issues with his vessels. The catheter was not inserted deep enough into the vein and that was causing it to leak. The surgeons replaced the vasccath and since then there have been no issues with it.
Due to all the vascath issues, the doctors had to push back removing his malincot drains (it was supposed to happen on Monday). Since they got the vascath under control Tuesday, they let him rest Wednesday, and then removed his manlincot drains on Thursday. They came out with no issue and everything still appears to be moving through his bowels as it should.
Later in the day on Thursday the dialysis pump clotted up and they had to take him off overnight. He started having really low blood pressure after that (means in the 20s). This continued through Friday and the docs thought that the malincot removal may have stirred some stuff up in his gut. They took blood cultures and labs to see if he had an infection, but other than the CRP being slightly elevated, they didn’t find anything. He was already still on antibiotics from his last infection so they continued those and added vancomycin just to be safe. They ran the antibiotics through yesterday (18JUL) and then turned them off because they never found any additional signs of infection.
He’s continued to have BP issues through today. His means have been bouncing between 30 and 70. They’ve had to turn his dopamine back on and right now he’s up to 17 on it. He has done really good on his vent settings. They’ve been able to wean almost every day since putting him back on last week. Right now he’s down to pressure of 21/5, rate of 20, and 34% O2.
They conducted a head and abdomen ultrasound yesterday and they both came back with no changes. Urology came by to explain that he still only has about 4ml of urine in his bladder which isn’t enough to reinsert a catheter. Right now the little urine he is producing is draining through his mucus fistula into his colon. They plan on closing that off once surgery goes in to repair his bowels. I also spoke to surgery yesterday and they’re being more cautious with their timeline than we thought. They want to try to start feeds next week in order to give his bowels a little more time to recover after removing the malincot drains. Typically they close up ostomys after about 2 months (which is where we are right now), but since his bowels tore and were so fragile when they removed his UVC, they want to be more cautious and give him some extra time before they reenter his abdomen. Makes sense since if they go in too early, it’s only going to mess things up worse and delay the attempt at PD even longer.

July 11
3670g (8lb 1.5oz)

July 12
3850g (8lb 8oz)

July 13
3720g (8lb 3.25oz)

July 13

July 14
3620g (7lb 15.7oz)

July 15

July 15

July 15
3630g (8lbs)

July 17
3740g (8lb 4oz)

The nurses were having fun fighting over who was Zeke's favorite :)

July 18
3690g (8lb 2oz)

July 19
3910g (8lb 10oz)

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