Monday, November 22, 2010

New line

Sam's surgery last night went well.  His old port was removed and a new Hickman Central Line was placed.  Overall I like where the new line was placed and was happy with the surgery results.

The removal of the port left a rather large wound on his chest which will need to be taken care of for awhile.  Not really looking forward to undressing the wound and repacking it, but we'll manage somehow.

Sam's surgery last night revealed some more concern for site access. It appears that during an earlier surgery Sam's right jugular was severely damaged or tied off.  This isn't that uncommon, but would have been nice to know.  Going back through the history of Sam's central lines it would have had to have been his very first line that was in that vein and the line was removed in Milwaukee - but none of the history that was sent to Boston or Madison has any notes regarding the line being in that vein and it is listed as being in the Right Subclavian vein.

After surgery last night they started to ramp up Sam's glucose.  It always seems that once we get off of his normal TPN cycle we have issues and this time will be no different.  His blood sugar spiked and remained high all night even when they reduced his intake down considerably.  This meant having to check blood sugar every hour last night.

Not sure yet when we are headed home, but today is looking less likely.  They would prefer to have his blood sugar be a little more stable before we leave.

Sunday, November 21, 2010

Bad Day

Today did not start well and really hasn't gotten much better as the day went on.

We have not been able to maintain Sam's blood sugar using his temporary IV that was placed.  He just simply requires too much sugar.  For the last six hours we have watched his glucose hover in the 30's no matter what we have done to try to raise it.  Therefore they are going to take Sam into surgery tonight, remove his old port, and put in a larger line.

The surgeon is on his way up to talk to me and it will be the same surgeon from this morning that I did not agree with.  I am not sure that I want Sam to have a PICC line in his arm for the next several weeks or months, and I do not like where he wants to place a new central line for Sam.

I will update again once we are out of recovery later tonight.


Since our last  post it seemed that things were improving.  Sam's port site was healing well and we were able to switch to a different huber needle for his port which seemed to irritate his skin less.

Last Sunday we changed out Sam's needle and dressing and the site looked the best that I have seen it since we began this whole ordeal.  Yesterday (Saturday) I went to de-access Sam (take out the old needle) and as I was working to get the dressing off could see that the skin under the needle head looked discolored.  As I got the needle out I realized that it was not discolored skin that I was seeing but the silicone on the top of his port.  The skin in the middle of his port, about 1 cm around, was just gone.

Since Sam is completely dependent on his TPN and IV fluids, he had to have an IV placed yesterday to keep him hydrated.  It did not go well.  It took several attempts over the course of 5 hours to get an IV placed.  In the process I think he was stuck at least 10 times and we blew three veins.  his poor arms and legs look terrible.  Since his TPN concentration is too strong to put through this type of IV we are just keeping him hydrated.

We were scheduled to go into surgery this morning to have his port removed, but we are now putting it off until tomorrow as there has been some disagreement as to what to replace the port with and when to do it.  Our surgeon will be back on tomorrow so hopefully we can all come up with a plan that everyone can agree on.