As some of you already know…it has been a very busy weekend. Late Saturday evening, Alex was not looking good at all. I had thought this all day but the Drs said that all his tests looked OK and that he was just worn out. The pediatric attending came around about 9pm. She didn’t even have to examine Alex to tell he was not doing well. His scalp has sunken in o the point where you could visible see his cranial bone protruding through the scalp and his ribs were protruding because his chest had sunken in. His stomach had become distended and rock hard. He was extremely pale and dry. She immediately left to go talk to the PICU Dr about moving him to another room so that he could be more closely monitored. Before we were moved they took Alex to put in a secondary IV port just in case the IV port in his head infiltrated. They got the port in quickly which shocked me at the time because he was dehydrated and most of his veins were already blown. At around midnight we were taken down to CT to have an abdominal ct scan with contrast. Keep in mind he had two functioning IV lines when we left the floor. About 15 minutes later in the CT room, the tech began to push contrast through his new IV line and it became infiltrated. They then proceeded to try and flush the IV port in the scalp which had also became infiltrated. They next 1.5 hours were spent with our nurses, IMC nurses, and PICU nurses try to place a functioning IV line so that he could receive fluid to help with his dehydration. They were unsuccessful so we went ahead with the CT minus the additional contrast. He had received some contrast via his NJ tube. The CT scan showed no visible abnormalities which was great, however i would have loved to find an explanation. We were brought back up to the floor where we were moved to an IMC room. IMC stands for intermediate care, which is classified as a step-down PICU unit. The patient to nurse ration is lower on this unit (3-1) and the vital checks and rounding are more often(vitals every 2 hours as opposed to 4/8). Once we were in our new room, they began trying to get the IV line again. This went on for another 1.5 hours. At this point the attending, who had spent most of the night with us advised everyone to let Alex (and the rest of us) get some rest and try first thing in the morning. A catheter was placed to monitor urine output and the NJ tube was hooked up to pedialyte to at least maintain some fluid intake. They sent off what blood they could get out of the various IV sticks for testing. Sometime later in the morning (around 4am) they came back and said that there was not enough blood to run the labs so they drew more blood. At 6:30 or so the nurses found a nurse who used to be head of the IV placement team (which was dissolved few years ago) to come and place his IV. He placed it in one quick try and Alex didn’t really cry. As the day went on they ran a million different tests on his blood, urine, and stools. The results came back showing signs of infection and inflammation but the Drs were unable to find a source. His blood levels were also considerable low. The lab cam and did a type and cross of his blood so that he could get a blood transfusion. It was decided that Alex needed to have a central line placed for TPN. Due to the possibility of infection and because of the unknown source of the possible infection the Drs were advised by the surgeons not to place a permanent central line in his chest. As an alternative the placed a temporary central line in his femoral vein in his right groin area. Overall the procedure went fine. While being sedated, Alex forgot to breath for a couple of minutes, but was assisted via a face mask with O2. He came out of sedation rather quickly at around 15 minutes. Throughout the day, Alex has continually low blood sugar levels. In the morning when it was first checked it was 36. He was given glucon orally to increase his levels rapidly. He was then hooked up to a dextrose drip through the IV. He received the blood transfusion around 9pm and TPN was started around 2am this morning. When we first came over to IMC we were in a double room but have since been moved to a single room in IMC.
INOVA Women and Children’s Center