Anthony Bissell
Anthony reached his goal of 50cc/hour via his J-tube at 7:00am this morning! So far he is tolerating it well. So, discharge is planned for this afternoon. We will continue with the TPN at home, until we are sure he will do OK with the J-tube feedings.
The resident just came in and removed Anthony’s sutures. Now we are just waiting for all the discharge orders.
We left off with Anthony being discharged Tuesday, February 8th with a goal of gradually increasing his J-tube feedings to 50cc/hour. This was not going well. He was barely tolerating 20cc an hour. On Wednesday night I had to shut off the feedings due to retching and gagging. Things were just not moving properly in his GI tract. Last night the feeding started leaking from around the tube and his abdomen was becoming firm and distended. My first thought was that the tube had been displaced and he might be developing peritonitis (a serious infection in the abdomen). We took him to the ER at 9pm Thursday night and the tests began. Not sure I can even remember all the tests, but this involved a night of blood work and x-rays that didn’t end until noontime today.
Anthony did have a fever and an elevated WBC (both signs of infection), but peritonitis was ruled out by a physical exam and a fluoroscopy study where they injected dye into his abdomen. While the dye did leak out from around the tube, it did not leak into the abdominal cavity. Good news. Looking at the CAT scan, it appeared as if the J-tube was kinked and may need to be replaced, which would mean another surgery. Before going back to the OR, the surgeon and radiologist decided to team up and see if they could correct the tube placement using a guide wire through the tube and visualization via fluoroscopy. Fluoroscopy is like real-time moving images using multiple x-rays. With some manipulation, they were able to get the tube properly placed. It’s hard to get a really good look with x-rays, but it seems that the balloon that holds the tube in place was defective. They managed to anchor the tube using a clamp system like the one in the post-op picture from my “Post-op Update, Day 2” entry. Eventually, once the J-tube tract is healed, they will replace this type of tube with something more permanent and secure. Hopefully, we won’t have this problem again.
So, the plan is to start over again with the J-tube feedings tomorrow, again with a goal of 50cc/hour. We shall see how that goes. I assume he will be discharged again with the PICC line and TPN until he reaches this goal.
I think that we have been spending way to much time in the hospital, as everyone knows us by name. Of course Anthony’s smile has become famous here on the Pediatric floor. Today, Anthony had two impressive student nurses caring for him. Both were first year students, but I could tell they will both become excellent nurses. Gives me some hope for the future of nursing. Tonight, Anthony has a male nurse. Male nurses are becoming more and more common too, which is also good for the profession IMHO.
Apologies for the delay in updating. I’ve been trying to catch up on life after hospitalization. Anthony was discharged from the hospital Tuesday evening, that is the good news. However, he is having trouble tolerating feedings via the j-tube. The doctors were trying to increase his feedings to the goal of 50cc/hour in order to discontinue his TPN and remove the PICC line. But every time they would increase his feedings beyond 20cc/hour Anthony would gag and vomit, even with his g-tube to drainage. So, we decided to continue the TPN at home and gradually – hopefully – increase his feedings. So, that’s were we are at now. The hope is that Anthony’s GI tract will start moving better with time.
We received a pile of letters and statements in the mail from our insurance company concerning Anthony’s recent hospitalizations. Here is a peek at one of the more amusing statements. Ya, I’ll get that check in the mail, LOL! Of course we will not be paying this amount, but I’ll likely spend a lot of time getting this stuff straightened out. Have I mentioned lately that our health care system sucks?
We were hoping that Anthony would come home today, but this morning, he had a lot of drainage around his J-tube. The drainage looked like formula, so the doctors had to hold his feedings and do a radiology study to check the placement of the tube. It took half the day to get this test booked and done, so there was not enough time to get him up to the volume he needs to be at for discharge. Here is a photo that I grabbed with my camera phone during the radiology exam.
Anthony is lying on his side, the metal in the right of the photo is from his spinal fusion. The dark spot is the dye in his small intestine, which shows that the tube is working well and there is no leakage. By the time he got back to the floor and the feedings were restarted it was 4:00pm.
The surgical team made rounds at 5 pm and said that they want to keep Anthony in the hospital one more night in order to reach a goal of 50cc/hour via the J-tube. They also want to discontinue the TPN, although I would like to continue it a bit longer to be sure he gets enough calories, but the team wants to remove the central line ASAP. No problem, one less trip to the hospital to take out the PICC line.
So, hopefully he will have a good night and will come home tomorrow.
Here is a little something that made me LOL. Looking out the window of Anthony’s room there is a big message in the snow. Most people think the medical students wrote this message in the middle of the night, but no one saw a thing.
Anthony had a good night and is now up to 30cc/hour of Peptamen via his new J-tube. I would guess that he will come home tomorrow if everything continues to go as planned. Tomorrow will be a busy day changing the dressing, maybe the tubes. Not sure if the current tubes are the same type he will come home with. Will also need to continue his TPN for a while as we work on increasing his calories via the j-tube. Will need new orders and supplies. So with all the paperwork etc, we will likely get home mid-to-late afternoon tomorrow.
Here is a photo of Anthony’s abdomen (apologies to those who might be a bit squeamish). They were able to use the same incision yet again, but this time not quite as long a cut.
