The Procedure

Today Andrew had a procedure to replace his G-tube with a GJ-tube. They wheeled him over to Sharp Hospital, which is next door. There's a tunnel on the lower level that goes between Sharp and Children's, so we took a field trip with his IV stand and nitric oxide cart. During the transport, the anesthesiologist gave him manual breaths so that the ventilator didn't need to go with us...once we arrived, they hooked him up to the ventilator in the procedure room. It was done in the "Interventional Radiology" department using a fluoroscope to get a live image of Andrew's inner abdomen.

The radiologist said that the procedure would take 30-45 minutes. An hour and a half later, I was still in the waiting room, wondering what was going on. When I asked at the desk, they called in to the room and were told that the procedure was just finishing up. The radiologist came out a few minutes later, soaked to the bone in sweat, and said, "Wow, that was really hard." Andrew is absolutely fine and the problem wasn't due to any complications, his anatomy was just a bit difficult to work with. It was hard for the doctor to get the tube through the pyloric sphincter, which is the ring of muscle between the stomach and the small intestine. He wasn't sure exactly why it was so difficult, whether it was a muscle spasm, extra tissue,or just an awkward anatomy...but it just took a little longer than he expected.

When they were done, Andrew was wheeled back over to Childrens' for recovery. He was fully sedated, which means all his ventilator settings were back up....thirty breaths per minute, higher oxygen, etc. As he starts to wake up, he adds his own breaths to the equation, allowing them to turn down the vent. They're going slowly, taking gases every four hours and only weaning a bit each time. As he gets closer to minimal settings, they'll start planning the extubation again....I'm guessing it wouldn't happen before Friday, and it could take as long as Monday.

They'll restart the feedings tomorrow, and hopefully the new tube will do its job. Andrew was continuing to spit up, even on reduced volumes (10cc per hour). They even tried adding some rice flakes to his milk, to add some density, weight, and calories. Nothing seemed to help. Even though most of his spit-ups happened at recognizable and understandable times (after being suctioned, while "stooling," or while getting upset), they were still concerning. We just don't want him to do damage to himself, either through aspiration of milk (going down the wrong pipe) or constant reflux burning his esophagus.

Enough for now....lots of work the next couple of days, plus a lot of stress in preparation for the extubation....time for bed, perhaps.