December 22nd: It sounds like Emmy will have a busy day today. The drainage from her right chest tube has slowed enough that it can be removed...yeaaaa!!! The final report from the ultrasound yesterday showed that she has a thrombus (or clot) at the end of her central line so they are starting a heparin drip to dissolve it. Dr Nigro ordered a repeat ECHO to check the pressure in her right ventricle to determine if the medication they added a couple days ago has been effective. As far as her feeds go, the physician agreed that she would benefit from speech and lactation consults. He wants to continue to advance her NG feeds despite her intermittent bouts of emesis, and they plan to start her on Prevacid in case the GI issues are partially related to reflux. Busy, busy, busy- fine with me as long as we keep moving forward!
Evening update: We accomplished all of our goals today. The right chest tube was removed so now she just has the one on her left side which is still draining significant amounts of fluid. The ECHO showed that her pressure in the right ventricle was improved but they decided to start her on another cardiac medication to further decrease her right ventricle pressure and improve heart contractility. The heparin drip was started to dissolve the clot at the end of the PICC and prevent it from dislodging and moving further into the heart.
We also made some progress regarding feeding today. Both the speech therapist and the lactation consultant came to see us and offered some great advice on starting feeds at Emmy's pace rather than pushing her to eat before she's ready. For now, we will continue with exclusive tube feeding and transition to oral feeds as she shows more interest. She's continued to have episodes of emesis with her NG feeds but they are advancing her feeds anyhow. The doctor feels she should be able to tolerate full enteral feeds and come off the TPN and lipids. The plan is to see how she does through the night and re-address her feeds in the morning.
I am looking forward to another night of snuggling in the chair with my sweet girl. I may be creating a monster by allowing her to sleep with me every night, but for now I don't care...she's spent way to much time laying in that warmer!!!
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