Partly Cloudy

Andrew's had a grumpy few days, mostly because of the various things they've been doing to him. Today he was a little calmer and much better with his breathing, but he was still getting upset almost every time he woke up. We can't be sure what's making him a little more volatile, but it's likely because his breathing tube was replaced yesterday. He's also growing up, and bigger/older kids have a harder time with being poked, prodded, and otherwise hooked up to various machines. I can't blame him, but it's always hard to see him unhappy. A lot has gone on, so let's break it into categories:

Feeding: Because he spit up a few times on 11cc per hour, they wanted to put in a GJ-tube, which I mentioned in a post a couple of days ago. This tube would replace the current G-tube, which goes into his stomach, with a longer one that goes into his small intestine. The procedure was to be done at the neighboring hospital, but they didn't have the appropriately sized tube. Instead, they decided to do it locally, and thread a smaller tube through the existing one. They tried it, but it didn't fit correctly; as a substitute, they put one in through his nose (an NJ-tube). After a little while with feedings through this new tube, he continued to spit up, this time with some bile included. So, they gave up on it, pulled it, and are going to order a better tube for early next week. Until then, they've resumed his feeds through the G-tube. After all the digestive trauma, he's still spitting up a bit, but there's no longer any bile.
SIDE NOTE: These tubes are named for where the ends are placed. The G is gastric, for the stomach, the N is nasal, for the nose, and the J is jejunal, for the upper portion of the small intestine. So, an NJ-tube would be naso-jejunal, from his nose to his jejunum.

Vascular: Andrew lost his arterial line again a couple of days ago, and they wanted it to be replaced before he was extubated again. Until it was replaced, they had to take blood from his heel, which of course he didn't like too much. They got another arterial line in his foot last night, so now they can test his blood pain-free.

Respiratory: Yesterday when they were doing the procedures (arterial and feeding tube), they had to anesthetize him first. They turned his oxygen and ventilator rate way up, as he wasn't breathing on his own. After the procedures, it took almost a day to get his rate back down to normal; they have to go slow and make sure he's ready for the drop in ventilation. Over the last 24 hours, he's gone from a rate of 30 to a rate of 10, and his oxygen percentage has dropped from 50% to 30%. He's back at minimal settings and back on his sprints. The sprints are now two hours long, and he's done well on all but one of them. They turned his pressure support back on, which means he has a little help overcoming the difficulty of breathing through a tube, and he's much happier.

The extubation plan is flexible, but it'll probably be early- to mid-week. I think they want to get his feeds back to normal (perhaps with a new GJ-tube), and they want to make sure his sprints are successful. It's important that he show some improvement on this extubation. If he doesn't noticeably improve or stay off entirely, they may give him another shot, but then they'll start talking about tracheotomies and other longer-term solutions. Those aren't discussions we're looking forward to, so hopefully he'll do as well as we know he can.

Last note- They just weighed him again, and he's at 5.42 kilograms, which is 11 pounds, 15 ounces.