For those who enjoy less typing, I set up a redirect to help you out.
If you type "www.avashines.com" or "avashines.com" in your web browser you will be automatically re-directed to this blog.
Or, you can type out the full "http://smittydotbat.blogspot.com".
No matter which way you prefer, you now have a choice... enjoy!
12/30/08
Tues 12/30/08 - - Another Tuesday in the OR
Today is a Tuesday, and yet again we found ourselves escorting Ava to the Operating Room. In comparison to the previous two Tuesdays is that this time it was for a pretty simplistic procedure to install a central IV line into her groin. There was no need to put her on the artificial heart-lung machine, stop her heart, or etc.... But they did have to put a breathing tube back in just for the procedure. However it did not remain in and was taken out prior to going back to her room.
Also while in the OR, they changed her vacuum dressing on her chest wound. The wound appears to be healing nicely and there has not been any return of pus or infection to the area. While surgery was taking place we once again waited in the Family waiting room with Nana, Papa, Grandma and Grandpa Smith and Aunt Christina while Aunt Leah and Uncle Andy watched the little ones. Hopefully this will be the last time we will be visiting the Family Room for that reason.
While both procedures were a success, the best news came during the morning rounds by the doctors and residents.
#1] Ava's blood culture from 12/28 was still negative - - this is the longest that a blood culture has made it negative thus far (note: the culture was still negative as of 20:00).
#2] The clot that was found on the 12/29 echo had not grown in size per today's echo. That means that the antibiotics and the heparin have a good chance to break up and dissolve the clot and hopefully Ava will not require another surgery. Routine echos will be performed daily to ensure that the clot does not grow, but so far - so good. We take good news any chance we can get!
Ava was actually flaring her arms and legs in happiness following today's OR visit and continues to sass the nurses. Teresa has also been able to lay in the bed with Ava and snuggle with her since we cannot hold her till tomorrow. She continues to be literally wrapped around our fingers and has been pacifying on Teresa's pinky finger for hours straight and will not take a regular pacifier for anything. She even cries when Teresa takes her finger away. There is still no fever to report and the overall outlook right now is leaning in her favor as long as the clot decides not to grow.
Also while in the OR, they changed her vacuum dressing on her chest wound. The wound appears to be healing nicely and there has not been any return of pus or infection to the area. While surgery was taking place we once again waited in the Family waiting room with Nana, Papa, Grandma and Grandpa Smith and Aunt Christina while Aunt Leah and Uncle Andy watched the little ones. Hopefully this will be the last time we will be visiting the Family Room for that reason.
While both procedures were a success, the best news came during the morning rounds by the doctors and residents.
#1] Ava's blood culture from 12/28 was still negative - - this is the longest that a blood culture has made it negative thus far (note: the culture was still negative as of 20:00).
#2] The clot that was found on the 12/29 echo had not grown in size per today's echo. That means that the antibiotics and the heparin have a good chance to break up and dissolve the clot and hopefully Ava will not require another surgery. Routine echos will be performed daily to ensure that the clot does not grow, but so far - so good. We take good news any chance we can get!
Ava was actually flaring her arms and legs in happiness following today's OR visit and continues to sass the nurses. Teresa has also been able to lay in the bed with Ava and snuggle with her since we cannot hold her till tomorrow. She continues to be literally wrapped around our fingers and has been pacifying on Teresa's pinky finger for hours straight and will not take a regular pacifier for anything. She even cries when Teresa takes her finger away. There is still no fever to report and the overall outlook right now is leaning in her favor as long as the clot decides not to grow.
Mon 12/29/08 - - Good News and Bad...
Monday was one of those 'take a step forward, two steps back' kind of days.
First, around 6:15 Ava was extubated off the ventilator.
We learned overnight that the plan was to extubate around 6:00.
At 5:30 they turned the ventilator onto the apnea-only setting meaning that the machine would only assist if it felt she was not breathing on her own.
Following the routine morning chest x-rays and blood culture draws, the extubation took place.
Teresa and I were so happy because Ava has really begun to show the spunk that we know and love and without the ventilator, she truly appeared to be progressing nicely. On top of that, she had good color, no fever, and at this point has been on IV antibiotics for one week.
During morning rounds, the 12/27 blood culture was still negative and Ava has yet to suffer a fever since the second surgery on 12/23.
Our optimism was short-lived though.
As the surgeon put it, "I have good news and not so good news..." (the good news was that Ava is still beautiful).
During the morning echo, there was emphasis on a foreign body which turned out to be yet another clot. This time it is in the outer part of the heart, where the atrium junctions with the superior vena cava - - the vein that carries deoxygenated blood from the upper body to the heart's right atrium.
According to the echo report and the discussions with the surgeon the clot was similar in size to the one that was surgically removed from the tricuspid heart valve just a week earlier. At this point in time, they are concerned about it, but are not at a point to panic or talk surgery. Since Ava has been on antibiotics for one week and because there is a chance that this could be a blood clot and not an infected vegetation, they are going to monitor and hope that the antibiotics and heparin will slow the clot's growth or break it up.
One thing to note is that echo results from the second surgery show that this clot could have been there already (just obstructed from plain sight), which is good if there is no witnessed growth in the upcoming days as that means that the antibiotics and heparin are keeping it at bay.
The surgeon also noted that Tuesday (between 9:00 and 13:00) would be the day that they are going to surgically insert another central line into Ava's groin for delivering meds and for drawing labs. The 24-48 hour period without a central line would be up then and the PICU staff was having a very difficult time trying to draw her blood (Ava's platelet count is elevated and she is starting to resemble a pin cushion with all of the prick marks covering her arms and legs.)
By surgically inserting the central line it is a lower risk for infection and bacteria attraction.
Around 16:00 we were informed that the 12/27 blood cultures did finally come back positive for MRSA.
It's a good thing that the central line is going to be put back in as one of the peripheral lines (the one in Ava's foot) became unfunctional.
At this point and time, Teresa and I remain positive as Ava looks and acts normally. We are scared about implications of this new clot, however, are confident that whatever needs to be done will be done to get our little girl healthy again. It's simply just going to take time.
First, around 6:15 Ava was extubated off the ventilator.
We learned overnight that the plan was to extubate around 6:00.
At 5:30 they turned the ventilator onto the apnea-only setting meaning that the machine would only assist if it felt she was not breathing on her own.
Following the routine morning chest x-rays and blood culture draws, the extubation took place.
Teresa and I were so happy because Ava has really begun to show the spunk that we know and love and without the ventilator, she truly appeared to be progressing nicely. On top of that, she had good color, no fever, and at this point has been on IV antibiotics for one week.
During morning rounds, the 12/27 blood culture was still negative and Ava has yet to suffer a fever since the second surgery on 12/23.
Our optimism was short-lived though.
As the surgeon put it, "I have good news and not so good news..." (the good news was that Ava is still beautiful).
During the morning echo, there was emphasis on a foreign body which turned out to be yet another clot. This time it is in the outer part of the heart, where the atrium junctions with the superior vena cava - - the vein that carries deoxygenated blood from the upper body to the heart's right atrium.
According to the echo report and the discussions with the surgeon the clot was similar in size to the one that was surgically removed from the tricuspid heart valve just a week earlier. At this point in time, they are concerned about it, but are not at a point to panic or talk surgery. Since Ava has been on antibiotics for one week and because there is a chance that this could be a blood clot and not an infected vegetation, they are going to monitor and hope that the antibiotics and heparin will slow the clot's growth or break it up.
One thing to note is that echo results from the second surgery show that this clot could have been there already (just obstructed from plain sight), which is good if there is no witnessed growth in the upcoming days as that means that the antibiotics and heparin are keeping it at bay.
The surgeon also noted that Tuesday (between 9:00 and 13:00) would be the day that they are going to surgically insert another central line into Ava's groin for delivering meds and for drawing labs. The 24-48 hour period without a central line would be up then and the PICU staff was having a very difficult time trying to draw her blood (Ava's platelet count is elevated and she is starting to resemble a pin cushion with all of the prick marks covering her arms and legs.)
By surgically inserting the central line it is a lower risk for infection and bacteria attraction.
Around 16:00 we were informed that the 12/27 blood cultures did finally come back positive for MRSA.
It's a good thing that the central line is going to be put back in as one of the peripheral lines (the one in Ava's foot) became unfunctional.
At this point and time, Teresa and I remain positive as Ava looks and acts normally. We are scared about implications of this new clot, however, are confident that whatever needs to be done will be done to get our little girl healthy again. It's simply just going to take time.
Sun 12/28/08 - - A New Strategy
Following the morning rounds we found out that Ava's blood cultures from 12/25 and 12/26 had come back positive for MRSA as well.
Though this is not entirely out of the ordinary for the infection that Ava has, the doctors were concerned that the infection was being drawn to where the central and arterial IVs were located.
As a new strategy, they decided to pull both of them and just leave two peripheral IVs. The belief is that with 24-48 hours without any central or arterial lines the odds of sterilizing Ava's blood goes up.
Ava resumed full feeds via the NG tube and started to really act like Ava - - even while on the ventilator. The sassy girl was trying to pull her NG tube, ventilator tube, and other wires/tubes so they had to restrain her right arm.
There is also talk about possibly extubating Ava from the ventilator on Monday morning as she is ready to breath on her own. In preparation they are stopping her feeds at midnight and will be lowering the dose of morphine she is receiving.
Though this is not entirely out of the ordinary for the infection that Ava has, the doctors were concerned that the infection was being drawn to where the central and arterial IVs were located.
As a new strategy, they decided to pull both of them and just leave two peripheral IVs. The belief is that with 24-48 hours without any central or arterial lines the odds of sterilizing Ava's blood goes up.
Ava resumed full feeds via the NG tube and started to really act like Ava - - even while on the ventilator. The sassy girl was trying to pull her NG tube, ventilator tube, and other wires/tubes so they had to restrain her right arm.
There is also talk about possibly extubating Ava from the ventilator on Monday morning as she is ready to breath on her own. In preparation they are stopping her feeds at midnight and will be lowering the dose of morphine she is receiving.
12/29/08
Inspirational Quote of the Day Apologies
The Blogger gadget I was using to provide the "Inspirational Quote of the Day" on this blog had a rather interesting quote from David Cort about sex being the great amateur art.
I would like to apologize if the quote offended anyone and would also like to note that I have switched to another quote engine ("Quotation of the Day") to ensure that no other questionable quotes get displayed.
I would like to apologize if the quote offended anyone and would also like to note that I have switched to another quote engine ("Quotation of the Day") to ensure that no other questionable quotes get displayed.
12/28/08
Sat 12/27/08 - - Recovery Day 4 (Round Two)
As Ava's daytime nurse put it, today was a pretty "boring day".
Ava remains stable, and they are starting to ween her off her dependency on the ventilator in hopes that her blood cultures will start showing negative traces of MRSA and we can progress further with her recovery efforts.
There was no echo scheduled for today.
Ava continues to receive around-the-clock doses of the vancomycin and gentimycin antibiotics (oxacillin was discontinued when it was found out it was MRSA as it will have no effect on it).
I heard through the grapevine that more people are going to be visiting this blog so I overhauled the layout including templates, and updated from the first surgery to current (I was slacking I admit...)
The original plan was this blog to be hosted at http://www.avashines.com, however, the Cleveland Clinic firewall prevents me from administering it (because of the TCP ports that it requires).
So, going forward I will produce daily updates for all at this location.
Teresa and I would like to thank everyone for their prayers and warm wishes thus far as they have been well received.
Please continue to check back for the latest updates....
Ava remains stable, and they are starting to ween her off her dependency on the ventilator in hopes that her blood cultures will start showing negative traces of MRSA and we can progress further with her recovery efforts.
There was no echo scheduled for today.
Ava continues to receive around-the-clock doses of the vancomycin and gentimycin antibiotics (oxacillin was discontinued when it was found out it was MRSA as it will have no effect on it).
I heard through the grapevine that more people are going to be visiting this blog so I overhauled the layout including templates, and updated from the first surgery to current (I was slacking I admit...)
The original plan was this blog to be hosted at http://www.avashines.com, however, the Cleveland Clinic firewall prevents me from administering it (because of the TCP ports that it requires).
So, going forward I will produce daily updates for all at this location.
Teresa and I would like to thank everyone for their prayers and warm wishes thus far as they have been well received.
Please continue to check back for the latest updates....
Fri 12/26/08 - - Recovery Day 3 (Round Two)
The AM echo was again negative on any vegetation on her valve.
The vacuum-packaged bandage on her chest from the second surgery went through a dressing change and per the nurse it was healing very nicely. During the second surgery, instead of suturing or using dermabond again to close the wound they kept the chest open and vacuum-sealed it with a foam packaging and a suction devise so that it heals from the inside out in a more controlled and sterile manner.
Father Al Krupp from Saint Agnes in Elyria stopped up to give Ava a blessing.
Ava started receiving formula feeds through a NG tube (2cc/hr @ 24 cal) so she is continuing to progress on the road to recovery.
All blood cultures gathered and tested in the labs so far have came back positive for MRSA.
The vacuum-packaged bandage on her chest from the second surgery went through a dressing change and per the nurse it was healing very nicely. During the second surgery, instead of suturing or using dermabond again to close the wound they kept the chest open and vacuum-sealed it with a foam packaging and a suction devise so that it heals from the inside out in a more controlled and sterile manner.
Father Al Krupp from Saint Agnes in Elyria stopped up to give Ava a blessing.
Ava started receiving formula feeds through a NG tube (2cc/hr @ 24 cal) so she is continuing to progress on the road to recovery.
All blood cultures gathered and tested in the labs so far have came back positive for MRSA.
- 12/21
- 12/22
- 12/23
- 12/24
Thurs 12/25/08 - - Christmas Day
Ava is our "Christmas Miracle".
She continues to fight (sometimes physically through sedation efforts) and show signs that she is gaining the upper-hand against the infection.
Again, the morning echo showed a strong heart with no reoccurring vegetation on the valve.
The chest tubes that were inserted during her second surgery were also removed - - a major indication that she recovering nicely from the surgery. She is still pretty swollen at this point, but is starting to break down the fluid and rid it via urine output.
The day was filled with visitors from grandparents to great grandparents; aunts, uncles, and cousins to her great ones. It was nice to have the support from both sides of Ava's family present to show their support in true Christmas spirit and fashion.
She continues to fight (sometimes physically through sedation efforts) and show signs that she is gaining the upper-hand against the infection.
Again, the morning echo showed a strong heart with no reoccurring vegetation on the valve.
The chest tubes that were inserted during her second surgery were also removed - - a major indication that she recovering nicely from the surgery. She is still pretty swollen at this point, but is starting to break down the fluid and rid it via urine output.
The day was filled with visitors from grandparents to great grandparents; aunts, uncles, and cousins to her great ones. It was nice to have the support from both sides of Ava's family present to show their support in true Christmas spirit and fashion.
Weds 12/24/08 - - Christmas Eve
Both sets of grandparents stayed the night following Ava's second surgery to help support Teresa and I. The nursing staff was busy, constantly tweaking meds to stabilize Ava's heart function and blood pressure. Though it was hard, Teresa and I were able to get some sleep.
In the early AM the echo revealed that there were no new masses visible on Ava's heart valve though there was some regurgitation or leaking present. Overall the staff of the PICU as well as the cardiologists and surgeons by how well Ava was responding though really starting to swell at this point (she was again put on the artificial heart-lung machine, however, unlike the first surgery her heart was not stopped).
The blood cultures that have been drawn daily up to this point have all came back positive with the staph infection. The growing concern is that this is an advanced strain called MRSA (methicillin-resistant staphylococcus aureus) which is difficult-to-treat in humans.
Still taking things day-by-day, but very thankful that Ava has progressed this far.
In the early AM the echo revealed that there were no new masses visible on Ava's heart valve though there was some regurgitation or leaking present. Overall the staff of the PICU as well as the cardiologists and surgeons by how well Ava was responding though really starting to swell at this point (she was again put on the artificial heart-lung machine, however, unlike the first surgery her heart was not stopped).
The blood cultures that have been drawn daily up to this point have all came back positive with the staph infection. The growing concern is that this is an advanced strain called MRSA (methicillin-resistant staphylococcus aureus) which is difficult-to-treat in humans.
- 12/21
- 12/22
Still taking things day-by-day, but very thankful that Ava has progressed this far.
Tues 12/23/08 - - Surgery #2
Overnight, Ava had a brief period of PVCs or premature ventricular contractions. On the monitor it looked like arrhythmia, however, the PVCs did not become regular in occurrence or in rhythm. The belief was that the PVCs were a side effect of the infection which by morning rounds was classified as staphylococcal aureus.
The AM echo revealed that the vegetation on Ava's heart valve had increased in size from 5mm to 7mm. At that current size and growth, it was determined that the IV antibiotics alone could not take care of the infection in the body.
An ultrasound also revealed another clot or series of small clots in the vein where the central line was following the first surgery. It was unknown whether or not there was an initial clot that became infected or if the clots themselves were originally caused by the infection.
Ava's blood pressure began to negatively fluctuate and it was at this time that the surgeon sat down with Teresa, me, and the family and started to go over the likelihood of a surgerical removal of the vegetation.
Simply put, the mass was big and Ava was more at risk - - especially if the vegetation released itself from the heart and traveled elsewhere like her lungs.
After a difficult discussion and reflection, Teresa and I gave consent for the surgeon to perform the second open-heart surgery in one week. Though the risks for surgery were stacked against her, Ava's initial congestive heart failure was mostly resolved at this point from the first repair surgery. Her heart function, lungs, and renal stability convinced the surgeon that this was the right thing to do and that Ava could handle it (and that it was the right thing to do).
After about two hours and some change we received word that the surgery was a success on many levels. First, they were able to remove the vegetation from her heart (we actually got to see it in a biopsy container) and second, they discovered that the wound from the first surgery was infected underneath the skin's surface (which probably was the culprit for the septic shock in the first place).
Though the surgery was a success, the next 24 hours are absolutely critical. The PICU staff will continue to fine-tune the medicines to ensure that Ava does not work too hard to function (heart beat, respirations). It is most likely that she will remain in the PICU for a long period of time.
The outlook is that each day will bring its own set of challenges for Ava and us, but the hope is that after about six to eight weeks of antibiotic treatment the infection should be successfully defeated and we can start to enjoy watching a healthy Ava grow and possibly go home for the first time since 12/16.
The AM echo revealed that the vegetation on Ava's heart valve had increased in size from 5mm to 7mm. At that current size and growth, it was determined that the IV antibiotics alone could not take care of the infection in the body.
An ultrasound also revealed another clot or series of small clots in the vein where the central line was following the first surgery. It was unknown whether or not there was an initial clot that became infected or if the clots themselves were originally caused by the infection.
Ava's blood pressure began to negatively fluctuate and it was at this time that the surgeon sat down with Teresa, me, and the family and started to go over the likelihood of a surgerical removal of the vegetation.
Simply put, the mass was big and Ava was more at risk - - especially if the vegetation released itself from the heart and traveled elsewhere like her lungs.
After a difficult discussion and reflection, Teresa and I gave consent for the surgeon to perform the second open-heart surgery in one week. Though the risks for surgery were stacked against her, Ava's initial congestive heart failure was mostly resolved at this point from the first repair surgery. Her heart function, lungs, and renal stability convinced the surgeon that this was the right thing to do and that Ava could handle it (and that it was the right thing to do).
After about two hours and some change we received word that the surgery was a success on many levels. First, they were able to remove the vegetation from her heart (we actually got to see it in a biopsy container) and second, they discovered that the wound from the first surgery was infected underneath the skin's surface (which probably was the culprit for the septic shock in the first place).
Though the surgery was a success, the next 24 hours are absolutely critical. The PICU staff will continue to fine-tune the medicines to ensure that Ava does not work too hard to function (heart beat, respirations). It is most likely that she will remain in the PICU for a long period of time.
The outlook is that each day will bring its own set of challenges for Ava and us, but the hope is that after about six to eight weeks of antibiotic treatment the infection should be successfully defeated and we can start to enjoy watching a healthy Ava grow and possibly go home for the first time since 12/16.
Mon 12/22/08 - - Infection Takes Its Toll
Following a night of fever and speculation of a possible infection (and a first-round dose of vancomycin antibiotics), Ava went into septic shock.
During an routine echo during the morning labs and work up, a vegetation (clot) was revealed near Ava's tricuspid heart valve. Though it was not apparent whether or not the vegetation was infected or was simply a routine blood clot, Ava went into a septic shock and had to go back on the ventilator.
During the septic shock Ava quit coherently responding and her right-side appendages started to turn purple.
All of us were deeply scared and concerned at this point.
Ava simply took a turn for the worse, and we were not sure if she was going to make it or not.
Following being put on the ventilator and the adjustment of her meds Ava became stable. Blood cultures still did not come back yet with anything detailed yet (though a quick report yielded there was an infection), so it was unsure of :
1. What type infection we were up against
2. How she became infected
The plan laid out by the attending PICU doctor, surgeon, and infections disease doctor was to intravenously attack the infection with vancomycin, oxacillin, and gentimycin. The hope is that the antibiotics will do the trick.
During an routine echo during the morning labs and work up, a vegetation (clot) was revealed near Ava's tricuspid heart valve. Though it was not apparent whether or not the vegetation was infected or was simply a routine blood clot, Ava went into a septic shock and had to go back on the ventilator.
During the septic shock Ava quit coherently responding and her right-side appendages started to turn purple.
All of us were deeply scared and concerned at this point.
Ava simply took a turn for the worse, and we were not sure if she was going to make it or not.
Following being put on the ventilator and the adjustment of her meds Ava became stable. Blood cultures still did not come back yet with anything detailed yet (though a quick report yielded there was an infection), so it was unsure of :
1. What type infection we were up against
2. How she became infected
The plan laid out by the attending PICU doctor, surgeon, and infections disease doctor was to intravenously attack the infection with vancomycin, oxacillin, and gentimycin. The hope is that the antibiotics will do the trick.
Sun 12/21/08 - - Recovery Day 5
Ava's fever was getting worse and there was more worry as to whether or not she had an infection.
There was a missed opportunity from Friday that made us believe that possibly it could be an infection in her central line. (there was an instance where Ava was drooling onto the openly exposed central line in her neck, though the dressing should have been changed immediately after it was noted that it was exposed.)
Both Teresa and I were able to hold Ava for the first time since pre-surgery and feed her orally with a bottle. Teresa was excited because Ava had been unable to feed from a bottle since a week or so after the original diagnosis.
But the fever was really starting to take its toll (Ava started to look sick) and they were using wash cloths soaked in ice water to lower her body temperature.
By the end of the night, the attending PICU doctor gave Ava the first dose of antibiotics (vancomycin) and removed the central line. A blood culture was drawn from both Ava's blood and the central line and sent to the labs to analyze for infection.
There was a missed opportunity from Friday that made us believe that possibly it could be an infection in her central line. (there was an instance where Ava was drooling onto the openly exposed central line in her neck, though the dressing should have been changed immediately after it was noted that it was exposed.)
Both Teresa and I were able to hold Ava for the first time since pre-surgery and feed her orally with a bottle. Teresa was excited because Ava had been unable to feed from a bottle since a week or so after the original diagnosis.
But the fever was really starting to take its toll (Ava started to look sick) and they were using wash cloths soaked in ice water to lower her body temperature.
By the end of the night, the attending PICU doctor gave Ava the first dose of antibiotics (vancomycin) and removed the central line. A blood culture was drawn from both Ava's blood and the central line and sent to the labs to analyze for infection.
Saturday 12/20/08 - - Recovery Day 4
The day started off on very high notes.
Teresa was able to take a nap next to Ava in her bed and the arterial line was discontinued.
Ava only had a central line in her neck at this point for any of her IV meds or fluids and the catheter was removed as well.
Ava was starting to resemble Ava in how she looked and how she acted.
Because of the ventilator she was a little hoarse when she cried or tried to coo.
By day's end though, we started to grow in concern because Ava started to show signs of a low-grade fever. There was some speculation that maybe Ava was getting sick or possibly had an infection, however, there was not much more to go on at this point (she was still in really good spirits).
Teresa was able to take a nap next to Ava in her bed and the arterial line was discontinued.
Ava only had a central line in her neck at this point for any of her IV meds or fluids and the catheter was removed as well.
Ava was starting to resemble Ava in how she looked and how she acted.
Because of the ventilator she was a little hoarse when she cried or tried to coo.
By day's end though, we started to grow in concern because Ava started to show signs of a low-grade fever. There was some speculation that maybe Ava was getting sick or possibly had an infection, however, there was not much more to go on at this point (she was still in really good spirits).
Fri 12/19/08 - - Recovery Day 3
Today was a very big day for Ava.
The swelling was pretty much disposed of at this point and Ava started to let it be known that she did not want to be on the respirator anymore.
The pacer wires for the external pace maker were removed in the early AM.
After pushing the breathing tube out of her mouth twice (the little stinker) the attending doctor had the respiratory team extubate her, permanently ridding her from the ventilator. The NG was also removed as part of the extubation process.
We were so happy to see our baby's face without all of the tubes (though there were some tape marks left behind).
Things are really starting to look good for Ava at this point.
The swelling was pretty much disposed of at this point and Ava started to let it be known that she did not want to be on the respirator anymore.
The pacer wires for the external pace maker were removed in the early AM.
After pushing the breathing tube out of her mouth twice (the little stinker) the attending doctor had the respiratory team extubate her, permanently ridding her from the ventilator. The NG was also removed as part of the extubation process.
We were so happy to see our baby's face without all of the tubes (though there were some tape marks left behind).
Things are really starting to look good for Ava at this point.
Thurs 12/18/08 - - Recovery Day 2
Today was very productive day in regards to Ava's recovery.
By the use of intravenous diuretics, Ava was starting to dispose of the fluid build up and swelling of from the surgery.
The drainage tubes in Ava's chest were removed as they were no longer necessary and the dressings covering her chest wound were removed.
At this point the respiratory staff were starting to minimize Ava's dependence on the ventilator and she was started on feeds through a nasogastric (NG) feeding tube.
By the use of intravenous diuretics, Ava was starting to dispose of the fluid build up and swelling of from the surgery.
The drainage tubes in Ava's chest were removed as they were no longer necessary and the dressings covering her chest wound were removed.
At this point the respiratory staff were starting to minimize Ava's dependence on the ventilator and she was started on feeds through a nasogastric (NG) feeding tube.
Weds 12/17/08 - - Recovery Day 1
Ava was pretty swollen (typical from being put on the artificial heart-lung machine) the day after surgery, however, was showing signs of significant progress.
The external pace maker was fine-tuned overnight so that it would only pace at pulses under 100BPM and was eventually turned off completely by day's end.
Overall, the night and day was spent by the PICU (Pediatric ICU) staff tweaking meds to try and stabilize Ava's pulse and blood pressure.
The external pace maker was fine-tuned overnight so that it would only pace at pulses under 100BPM and was eventually turned off completely by day's end.
Overall, the night and day was spent by the PICU (Pediatric ICU) staff tweaking meds to try and stabilize Ava's pulse and blood pressure.
Tues 12/16/08 - - Surgery Day
Today was the day that we have been waiting for since the diagnosis back on 10/16 - - The large VSD that was causing Ava to work so hard to breathe and her little heart to beat was going to be patched.
We arrived at the Cleveland Clinic Children's Hospital around 6:00 and check in at a step-down unit for pre-surgery vitals and check-in. Both sets of Ava's grandparents as well as her Aunt Christina were there to wish her well.
Teresa and I escorted Ava to the Operating Room, and though it was difficult to turn her heart into surgeon's hands we knew that it she would be in the best set of hands to see Ava to a normal life.
Ava's surgery took a little over eight hours.
It consisted of...
The surgery was a success.
Per the surgeon, theVSD was the size of a quarter (which judging by the total size of Ava's heart was a pretty significant hole).
There were some signs that Ava was going into post-operation condition called "heart block" so an external pace-maker was used for about an hour to keep her beats in rhythm, however, by the time we met back up with Ava in the ICU she was using the pace maker in standy-mode (it would only pace her heart if she fell underneath 120 BPM).
Though she was starting to swell and was sedated on a ventilator in the ICU, the outlook for Ava was pretty high.
She had a central line in her neck, an arterial line in her arm, the external pacer wires going into her heart through her chest and some drainage tubes in her chest for any excess fluid.
We arrived at the Cleveland Clinic Children's Hospital around 6:00 and check in at a step-down unit for pre-surgery vitals and check-in. Both sets of Ava's grandparents as well as her Aunt Christina were there to wish her well.
Teresa and I escorted Ava to the Operating Room, and though it was difficult to turn her heart into surgeon's hands we knew that it she would be in the best set of hands to see Ava to a normal life.
Ava's surgery took a little over eight hours.
It consisted of...
- Anesthesia & Cooling Down of Ava's Body
- Placing Ava on the artificial heart-lung machine for open heart surgery
- Stopping Ava's heart (her heart was stopped for about 54 minutes)
- Sewing a Gore-Tex patch the the septal wall that seperates the ventricles
- Repairing an ASD between the atria
- Starting Ava's heart back up
- Removing Ava from the artificial heart-lung machine
- Using a cloth-like substance to fuse her sternum back together
- Dermabonding Ava's chest wound together and securing with steri-strips
The surgery was a success.
Per the surgeon, theVSD was the size of a quarter (which judging by the total size of Ava's heart was a pretty significant hole).
There were some signs that Ava was going into post-operation condition called "heart block" so an external pace-maker was used for about an hour to keep her beats in rhythm, however, by the time we met back up with Ava in the ICU she was using the pace maker in standy-mode (it would only pace her heart if she fell underneath 120 BPM).
Though she was starting to swell and was sedated on a ventilator in the ICU, the outlook for Ava was pretty high.
She had a central line in her neck, an arterial line in her arm, the external pacer wires going into her heart through her chest and some drainage tubes in her chest for any excess fluid.
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