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Posted 2015-10-30T01:04:00Z

Post for October 26, 2015 - Start of Week #14 in CVICU J5-5 & #1 Dose of tPA

Post for Monday, October 26, 2015

By the time I got groceries @ Costco & Wal-Mart, shopped for other items, traveled back to the Transplant House, made several trips to unload the groceries, put away groceries, fixed something to eat, showered, replenished clothing & food items to take to the hospital, returned to the hospital, & went through security at the front desk, it was 2a before I was back at his bedside.  Nate RN said he had been so anxious & worried while I was gone.  After kissing him & reassuring him that I was okay & here, I too “hit the hay.”  Perry had several awakenings throughout the remainder of the night.  He has developed a brand new silent hand sign language for all the things he’s wanting done with each position change that I am still trying to learn & relay to the staff what each gesture means.  Finally I said, “Honey, PLEASE use words too to tell us what it is that you’re wanting, so maybe we can figure it out & get it right!!”   Neither Nate RN nor the Clinical Tech were brave or bold enough to say that to him, but it certainly helped.  The Clinical Tech said “I can tell you’re married” & Nate RN teased him & said, “You wanted her here remember.”

Formula feeding was held @ 5a in preparation for tPA procedure later today.  Melissa RN was his assigned day shift RN.  Dr. Maryam Valapour, Pulmonologist, had made rounds early this  morning while we were both asleep.  I informed Perry that our good friends, Greg & PJ had contacted me yesterday to inquire if it was okay if they came to visit this Friday & Saturday.  I am hoping that their visit will help to perk his spirits up, & I feel it will benefit of us too.  Matt RT capped Perry’s trach @ 945a on 2.5 liters of oxygen supplementation via nasal cannula which was decreased from 4 liters.  He was able to tolerate capping rather well today with oxygen saturations between 97-100% until 1150a.  Although he was exhausted he had a new record of 2 hours & 5 minutes.  He was then switched to BiPap mode on the vent via face mask with his trach still being capped @ 1150a.  He soon fell asleep.  At 125p, he was converted back to trach capping on 2.5 liters of oxygen via nasal cannula but started to experience more labored breathing & discomfort to his sides, so he received Tylenol @ 142p by Rachael RN.  By 155p, he was returned to vent & had a complaint of a headache.  He soon fell asleep after additional comfort measures.

Dr. Aaron Douglas, Intensivist, came in while Perry was sleeping & informed me that Dr. Eric Kaiser, Intensivist, had ordered for tPA (Tissue plasminogen activator) to be given, so he would be administering it upon it’s arrival.  I asked him whether or not Dr. McCurry had spoken with Dr. Murthy as I had been informed that was going to occur but no one had yet informed us whether that had actually happened.  Dr. Douglas relayed my question to Nicki, APN & she soon came to inform me that she had contacted Dr. McCurry & that Dr. McCurry confirmed that Dr. Murthy & several other thoracic surgeons as well as Dr. Christine Koval, Infectious Disease, had been included in the decision to go forward with giving tPA.

At 410p, Dr. Douglas added a stopcock to the pigtail chest tube catheter & instilled tPA 5 mg in 100 mL sterile normal saline & then clamped the pigtail catheter.  His formula feeding was resumed by 430p & Perry’s position was changed ~every ½ hour until 6 p to allow the medication to hopefully surround more of the hematoma (clot).  At 6p, the pigtail catheter was unclamped & within the first hour 140 mL serous (blood-tinged) drainage in addition to the 100 mL normal saline equivalent had drained. Good so far.  

Perry’s weekly dose of Erythropoietin to stimulate his bones to produce red blood cells was increased to 60 mcg IV from 40 mcg given last week.  The evening progressed without complications & with ~350 mL total of serous drainage from the pigtail catheter by midnight.  All good indications that may prevent Perry from having to undergo another open chest surgical procedure to remove the clot.

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