Sunday, January 23, 2011
Saturday, January 22, 2011
Look, no nasal cannula!
I was wrong yesterday. I thought that we would limp along to the point where we could remove the lines in Caleb's heart. Caleb and his medical crew thought otherwise. We aren't limping, we are sprinting! Today was another great day.
Caleb's lungs were still looking better, so they weaned the high flow air down again and removed the nasal cannula entirely by 1:00 pm. As of 10:00 pm, he was still off all respiratory assistance and his oxygen saturations were higher than they were with help.
Caleb's blood pressure has not been creeping as high, so they increased his oral blood pressure medicine and eliminated his IV medication to lower is blood pressure. One less continuous drip to worry about.
Caleb's morphine wean last night went well, so they eliminated his sedative today. He was a little jumpy, but was always able to be consoled when he got wound up. Considering we still can't hold him, this is huge. Another continuous drip eliminated.
Caleb has been peeing like a champ, so they eliminated one of his IV diuretic doses. Cutting down on the diuretic doses helps his electrolytes - especially his potassium - to stay in better balance. This means fewer intermittent IV medications.
Caleb is more alert and recognizes Phil and I. There is always a concern for damage with the large amounts of abuse their bodies take from the bypass, lower oxygen saturations, heavy drugs, etc. We think that Caleb's neurological function is fine.
Caleb is up to full volume for feeding. He is actually getting 10 mL more milk per feeding than he was at home. He seems to be tolerating it well. He did spit up some tonight, but it could just be that he is getting fed faster than he is used to or it could be that he is a baby and sometimes babies spit up.
Tonight, Caleb's morphine will be weaned again - from 30 to 20. The nurses all know that he had problems weaning before, so they are being extra vigilant with his pain control. They are using the tylenol and oxycodone so hopefully we can avoid the additional doses of morphine that he got last time. So far, this has been going very well.
The plan for tomorrow is to switch his IV diuretics over to oral and start adding the extra formula to his milk to increase it from 20 calories per ounce to 22 calories per ounce.
If things look good tomorrow - if he is not too agitated from the morphine wean, if his diuretics switch is working, if his electrolyte imbalances can be controlled with oral methods and his blood pressure stays where they want it - they may remove the lines in his heart tomorrow. This will also allow them to remove his chest tubes if the lines in his heart come out without causing bleeding. Tomorrow could be a very interesting day. Maybe you can get better at having heart surgery with practice!