Post for Thursday, October 29, 2015
Perry slept well during most of the night with his usual awakenings. Audra RN was his day shift RN. Trach capping per Bill RT began @ 951a on 2.5 L oxygen supplementation via nasal cannula. Perry again began to experience extreme warmth, increased abdominal movement, & difficulty with more labored breathing so capping despite comfort measures of ice cold washcloths & fanning, so he was uncapped @ 1021a after completing 30 minutes. He returned back to sleep rather quickly.
Dean PT came to check on Perry & due to exhaustion he declined PT. Dr. Douglas then rounded & stated he spoke with Dr. McCurry today, & the plan is to give an additional dose of tPA 5 mg into the pigtail chest tube catheter today & repeat a chest CT scan tomorrow. There has been a total of 610 mL drained from the pigtail since the tPA was given on 10/26.
At 1200, Dr. Douglas administered tPA 5 mg in 100 mL sterile saline via the L chest pigtail catheter without difficulty & the catheter then clamped until 3p. He also discussed how the lymph nodes during dissection of the lungs can be damaged & typically people drain their pleural (lung) space into the thoracic lymphatic drainage system duct so that can be part of the problem. We changed Perry’s position every hour to allow the tPA to surround as much of the loculated effusion as possible.
Dialysis started @ 135p. Due to extreme exhaustion, Perry also declined OT when Kim rounded. Rachael RN took over for Audra RN @ 3p with Perry continuing to remain asleep.
The pigtail catheter was unclamped @ 325p & shortly thereafter Dr. Douglas came in to assess the drainage & gave a thumbs up. Additional position changes were made intermittently but limited due to dialysis & sluggishness of the dialysis catheter when turned to his right. Dialysis ended @ ~510p with a total of 500 mL of fluid removed. Perry continued to sleep intermittently into the evening hours.
Due to Hepatitis B Core Risk transplanted organs having been received, I confirmed with Carl, his night shift RN, that Perry’s post-transplant hepatitis panel due on 10/27 had been drawn. The panel was completed, & the results have remained negative which is good news.
The remainder of the evening was uneventful with serous (blood-tinged) fluid continuing to drain from the L pigtail chest tube catheter - again good news.