So Close, but No Enchilada

Mireya remained fever free overnight. Her white and hemoglobin counts also increased. The platelet count remains high following the transfusion yesterday which is really good. We had a bit of an issue when the nurse came to draw her culture. She went in for the stick and it just didn't work out. I realize this can happen from time to time, however, I do not expect you to keep pushing a needle in a dead space and causing the area to swell because you are now maneuvering where you shouldn't be. Mireya was in hysterics at this point, so I politely instructed them if there was any question on whether or not they could be successful a second time, they needed to call on someone they know does it routinely and with accuracy. It would be no problem to request someone from the PICU or Pediatric E/R to come up and do it for us. I recognize some of the nursing staff are not regularly doing draws or starting IV's, but this was not the time to try to figure it out. They quickly polled their resources and called upon an All-Star on the floor and got it done.

We had a short discussion with the Medical team yesterday about intravenous catheter options. After the incident this morning, I'm even more on board with how much easier life would be for Mireya with one in place. We talked about tentatively having a pic line inserted today if there was no fever. Somewhere between tentative and 11:55 it was shared with me that it was scheduled for sometime today and that Reya could not eat after 12:00am. Gotta love a 5 minute notice for a child that is fast asleep. I did manage to get her to drink a little something, but that was it.

The team came to discuss the pic line and check out her vein prospects via ultrasound. B-I-N-G-O we have a winner, we'll be back shortly so we can put it in. We were all sharing with Reya how this would help her and eliminate the need for multiple sticks and how she could get her medication through it too. Of course she was clueless, but no more sticks made her smile. We knew she would need to be sedated for the procedure and the way they talked about it made me think it would be a fairly swift process. When we got to the PICU area I learned the procedure would take about 30 minutes, but once it was in they would need x-rays and to complete several additional things before it could be used. Essentially she would need to be over there for several hours. Mireya went under very quickly, less than 20 seconds and she was out and comfortable. The environment has to remain sterile throughout the process, so my non-sterile self was asked to come back in about a half hour.

Upon my return I learned that the line didn't take. After several attempts the wire just wouldn't thread through her vein so they had to abort the mission. No one told us there was any chance of it failing, so I was sort of in limbo emotionally. I looked at Reya still out cold on the table with several small puncture areas on her arm and my heart sank. I wanted this to be over, I wanted it to work, I wanted it to eliminate her being stuck a zillion times for meds and counts. There was a solemness in the room as we waited for her to wake up. I asked them how often this happens? The failure rate is usually 1 out of 5. The technician told me she tried, but just couldn't get it to take and after so many attempts they felt it best to stop. I'll admit it felt like defeat and then that sweet little girl opened her eyes and my only concern was to feed her and speak to the doctors about the next steps. There was mention of putting in a Hickman line, but that would require the Radiology team and they were unsure if it could be coordinated so quickly. We held off on feeding Reya just in case it could.

Mireya wasn't very hungry which was hard to believe after 16 hours, but also a blessing should she have the other line inserted. After an hour or so she nibbled on a few Cheez Its, but completely ignored the food they brought to the room. Another hour or so passed and the Dr. came in to answer any questions and give us discharge instructions. There was no reason to keep her since the fever has subsided and there was no infection in the cultures. We have to continue to be diligent in guarding Mireya against illness and infection, because even though the white cell count has increased the cells that fight infection are still very low. Fever would be our #1 indicator of infection. Reya was given another type of medication to assist her body and maintain her counts, but she would need it for at least 2 more days. The medication is given via injection which is not something I would be comfortable doing at home, nor is Quentin. We talked more about outpatient options for the Hickman line, but once the Dr. realized Reya hadn't really eaten yet she pulled out all the stops to see if she could make it happen. We received word that it could not happen today, but would take place first thing in the morning.

We are believing this procedure will be a complete success from start to finish and that Reya will be able to come home tomorrow. If at first you don't succeed, pray and try again!