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.
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment