I left off last Tuesday when we were waiting for discharge from the hospital. We were literally discharged and on our way out the door when the nurse decided to give Anthony a dose of Flagyl (an antibiotic drug), so that he would not miss a dose. The Flagyl was very thick, sticky and gritty and it stuck to the inside of the J-tube, blocking the tube. We tried everything to unblock it, and in the process of trying to clear the tube, it was torn. At that point, there was nothing left to do but try and replace the tube.
Anthony went back to the floroscopy room where they threaded a wire through the broken tube, and removed the tube while leaving the wire in place. They then ran a new tube over the wire. The wire is used for proper placement and can be seen via x-ray. The first attempt with the same size tube (14Fr) failed, but they were able to get a smaller tube in place (12Fr). They then instilled contrast dye into the new tube to check placement. Since Anthony was already technically discharged, the doctor agree to let us go home with the new tube. So, again, we started off slowly and we gradually increased his feedings.
He was doing well and up to 40cc per hour (while still receiving TPN). Last night he had a fever, which was worrisome. So many possible sites of infection (and his Flagyl had been discontinued because of the issue with the J-tube). I gave him some Motrin, but today he was still febrile. Obviously, he had an infection somewhere. I called the surgeon hoping to get an antibiotic order over the phone, but the covering doctor was concerned that Anthony might be septic from his central line. True, could be his PICC line, could be a number of things going on with his tubes and bowels, could be pneumonia, as Anthony has a chronic cough due to aspiration.
So, off to the E.R. yet again. By the time we got the the hospital, Anthony’s temp was 103. They started off with IV fluids, blood work, including blood cultures, a chest x-ray and a urine test. After several hours in the E.R., they came to the conclusion that Anthony had a UTI (urinary tract infection). That would have been one of my last guesses after the PICC line, J-tube, G-tube, surgical incision, sepsis, peritonitis, pneumonia… So, I guess a UTI is good news. They gave him an IV dose of Levaquin (a broad-spectrum antibiotic). We will continue the Levaquin via his J-tube for 10 days at home.
We are home now and very happy that Anthony did not need to be readmitted to the hospital. He has a follow-up appointment with his surgeon next Wednesday. Until then, we will work on getting him to tolerate 50cc/hour of Peptimen via his J-tube. The next step is to discontinue the TPN and remove the PICC line.