PICC

I have never seen a person as swollen as Averi.  They weighed her yesterday and she's gone from 18 to 25 pounds since she's been admitted.  That's almost a 40% weight gain, and it is all fluid.

Yesterday was a little crazy.  The final results came back on the broviac cultures (proving that she was indeed growing the same bacteria as before and it had set up shop in her tubes) and Averi went down to Interventional Radiology at 1:00pm to have her PICC line put in.

The 30 minute procedure took over an hour because she is SO swollen.  She's little to begin with, she has smaller veins, and she's being given medications to improve her blood pressure which in turn shrink her vessels.  The pressure was really on because she is getting so many medications that she has to have a central line with a double port (also very hard to do on babies).  Luckily, we had a little miracle and they were able to not only put the line in, but put in a double port!

The PICC had to be put in her leg, instead of her arm, to save the upper veins for the next broviac (which will have to be put in on the right side instead of the left).  Apparently every time you put in an IV or central line, it causes scarring and can make that vein unusable again.  I'm pretty sure Averi will just be one big scar by the time she's done with all this.

We were supposed to go down to the OR shortly after having the PICC put in and switching all the meds over to the new line, but that wasn't the case.  We waited for the rest of the afternoon, while putting off meds that would help with her swelling so that they wouldn't interfere with the anesthesia, and never made it to the OR.

Around midnight, her oxygen saturation went way down and they had to bag her until she slowly brought it back up.  She had so much fluid in and around her lungs that they weren't staying open and the pressure of the vent had to be largely increased.  I guess this finally proved to the doctors how much she needed the lasix (the drug that makes you pee off the fluid) and they gave her a dose.

(I can't close her hand any more than this because her fingers are so swollen.)

Not even an hour after she had finally calmed down, I was woken up to find the surgeon and 2 OR nurses in our room.  Apparently they just showed up and decided to remove the broviac bedside...at 1:30 in the morning.  They set out their sterile field and got to work removing the stitches and pulling out the line.  They didn't even close it up, explaining that they didn't want to seal in the infection and that the body would close it on it's own.  Had we known that they were going to do it bedside, we could have been giving her lasix all day long...I love good communication!

Gratefully, once the broviac was out they started Averi on a continuous lasix drip and she started peeing.  Unfortunately, the lasix isn't compatible with some of the other medications she is getting and has to be administered through the IV on her foot.  Since that IV and both ports on her PICC are being used, another IV had to be put in.  I woke up this morning to find an IV in her head.  I guess that was the only vein they could find that wasn't covered by 5 inches of fluid.

The rest of the day went pretty smoothly and Averi continued to pee and then pee some more.  Tonight you can actually open her eyelids a little bit and her tongue isn't so swollen that you can see every single taste bud poking out of it.  I know we still have a ways to go, but at least she is working on improving.