Day 3 was a busy one. It started off with what became the norm in the PICU - the daily chest x-ray at 4:30am. After all the stress of the A-line, I was just settling to sleep before needing to leave the room for William's x-rays and another little baby in the suite.
Shortly after, the fellows came by to check on our little sleeping prince. They reviewed William's blood pressure trends and planned to wean him off the dopamine. By 6:15am, his BP was holding steady around the upper 80’s over 30’s....without dopamine. One major accomplishment done.....check!
7am brought a beautiful sunrise and one of our favorite nurses, Char on duty. As she was doing her initial exam, I noticed that William’s left foot was blue, almost purplish on the bottom. Knowing the arterial line had just been placed in his groin area of that leg same leg, we all became concerningly alarmed. Both nurses covering the three beds in our PICU suite could not get a pulse and the left leg and it was obviously cold.
Char paged the attending STAT and after a whirlwind of chaos, that darn A-line (that was just placed at 3:30am) was removed at 8:30am...by the same attending who put it in just five hours previously. There was a lot of concern William's artery had clotted. They promptly called vascular surgery who came and said he thinks its just the femoral artery reacting to the arterial line. He didn’t think it was a clot and didn’t think William needed an ultrasound because his arteries are so small it is difficult to see on ultrasound. The clearly irritated vascular resident also added, "Anyway, there are no vascular techs available today, since it's Sunday....maybe an ultrasound could be done tomorrow."
Anyone who knows me would know what to expect from my reaction to his nonsense response. I was clearly not happy with this answer, since a clot could be fatal or very serious, at minimum. I told nurse Char who went to her charge nurse and the attending. The attending resident came and apologized for the vascular doc and said she will ensure all is done that is needed. She had already called Dr. LaQuaglia’s cell phone and left a message for him to come in.
In the meantime, William received another blood transfusion, after his hemoglobin was at 7. He also got an additional albumin infusion and needed a new IV for frequent lab draws and medication infusions. This time around, it only took 4 stabs through William's terribly puffy skin to hit a good vein in his right foot.
By 10:00am, a hematologist came to examine William and give input about the cold leg. She advised to give a blood thinner, to be most pro-active in preventing permanent damage from what she considered to be an obvious blood clot in his femoral artery. Because William was still less than 48 hours post-op, she needed to review her recommendation with Dr. LaQuaglia. In the meantime, we kept warm packs on William's lower leg and monitored him closely.
Around 2pm, Dr. LaQuaglia came in to see William. He examined him carefully and assured us that William’s leg will be just fine, saying "this is nothing....this is no big deal." I have to say, my stress level seemed only to increase with this answer....given that William's foot was still cold, blue and pulseless. Dr. LaQuaglia went on to explain that he wrote a paper on this exact thing. All we could hope for was that this too shall pass...hopefully.
We were only on Day 3, but were really feeling the stress. There was CONSTANT noise in William's PICU room. There were two other severely ill babies sharing our suite....all on vents and monitors galore. The nurses were continuously hustling....and William was just constantly keeping everyone on their toes.
I remember going through the bag I had brought to Sloan on surgery day. It had the clothes William wore the morning of surgery and some of his favorite toys. For a little stress relief, we gave Sophie, the squeaky giraffe a tour of William's room.
She enjoyed the view of the river...
Shortly after, the fellows came by to check on our little sleeping prince. They reviewed William's blood pressure trends and planned to wean him off the dopamine. By 6:15am, his BP was holding steady around the upper 80’s over 30’s....without dopamine. One major accomplishment done.....check!
7am brought a beautiful sunrise and one of our favorite nurses, Char on duty. As she was doing her initial exam, I noticed that William’s left foot was blue, almost purplish on the bottom. Knowing the arterial line had just been placed in his groin area of that leg same leg, we all became concerningly alarmed. Both nurses covering the three beds in our PICU suite could not get a pulse and the left leg and it was obviously cold.
Char paged the attending STAT and after a whirlwind of chaos, that darn A-line (that was just placed at 3:30am) was removed at 8:30am...by the same attending who put it in just five hours previously. There was a lot of concern William's artery had clotted. They promptly called vascular surgery who came and said he thinks its just the femoral artery reacting to the arterial line. He didn’t think it was a clot and didn’t think William needed an ultrasound because his arteries are so small it is difficult to see on ultrasound. The clearly irritated vascular resident also added, "Anyway, there are no vascular techs available today, since it's Sunday....maybe an ultrasound could be done tomorrow."
Anyone who knows me would know what to expect from my reaction to his nonsense response. I was clearly not happy with this answer, since a clot could be fatal or very serious, at minimum. I told nurse Char who went to her charge nurse and the attending. The attending resident came and apologized for the vascular doc and said she will ensure all is done that is needed. She had already called Dr. LaQuaglia’s cell phone and left a message for him to come in.
In the meantime, William received another blood transfusion, after his hemoglobin was at 7. He also got an additional albumin infusion and needed a new IV for frequent lab draws and medication infusions. This time around, it only took 4 stabs through William's terribly puffy skin to hit a good vein in his right foot.
By 10:00am, a hematologist came to examine William and give input about the cold leg. She advised to give a blood thinner, to be most pro-active in preventing permanent damage from what she considered to be an obvious blood clot in his femoral artery. Because William was still less than 48 hours post-op, she needed to review her recommendation with Dr. LaQuaglia. In the meantime, we kept warm packs on William's lower leg and monitored him closely.
Around 2pm, Dr. LaQuaglia came in to see William. He examined him carefully and assured us that William’s leg will be just fine, saying "this is nothing....this is no big deal." I have to say, my stress level seemed only to increase with this answer....given that William's foot was still cold, blue and pulseless. Dr. LaQuaglia went on to explain that he wrote a paper on this exact thing. All we could hope for was that this too shall pass...hopefully.
We were only on Day 3, but were really feeling the stress. There was CONSTANT noise in William's PICU room. There were two other severely ill babies sharing our suite....all on vents and monitors galore. The nurses were continuously hustling....and William was just constantly keeping everyone on their toes.
I remember going through the bag I had brought to Sloan on surgery day. It had the clothes William wore the morning of surgery and some of his favorite toys. For a little stress relief, we gave Sophie, the squeaky giraffe a tour of William's room.
She enjoyed the view of the river...
and just had to kiss her sweetie William....
...and of course, they needed some cuddle time together.
That Sunday, we were blessed with a visit from Uncle Alan and Aunt Laureen who traveled from Connecticut to support us. As they were ready to head out of town, they dropped Fred and I off at Ronald around 5pm. We crashed.....and crashed hard. I woke at 11pm in a complete panic. I had that feeling of, 'where am I, what day is it.....what has just happened to me." Yeah, it was called s-l-e-e-p....remember that novelty?
We received great news when we got back to William, Grammy and Poppie. A pulse had finally been found in William's foot! It was faint, but audible with the aid of a Doppler....thank god!
Later that night, they also weaned William's vent from 16 breaths per minute to 14...he was making some breathing attempts!
~ William and nurse Char ~
She was an awesome advocate & skilled nurse to have on our side through all the stress of the pulseless foot. Definitely a nurse we will always remember...
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