The Central Line

Dale was supposed to post this a week ago, but didn't get a chance to so, a little late, but here's the scoop.


There was a reason our doctor didn't want a central line put into Ethan past 8:00pm....people get tired and make mistakes.

It's now 1:30am on Saturday (April 2) and I just came across another error with Ethan's line...very scary!

Just to back up a little...Ethan isn't sick enough to be in NICU or PICU (which is where we want him to be) so he has ended up on the Surgery and Burn Ward because his doctor here is a surgeon and there is still a chance that Ethan may need surgery. He needs a central line put in because he will be receiving TPN and lipids for a while and both of those can quickly burn out arm and leg veins, so they are going to go through his groin into the Femoral Vein (not sure if I spelled that right!) And since the NICU/PICU team won't cross over into the rest of the hospital they won't put in Ethan's line - even though they have the most experience with this with small babies and can do it easily...so, Ethan needs to be put out and intibated in the Operating Room just to get a line put in. So....now back to the story...

Our doctor, Dr Milbrandt (who has been wonderful) worked during the day and another surgeon was on in the evening. Ethan was to be fit in whenever there was time to do his surgery. The nurses' station got a call at around 8:45pm saying Dr Lumin was just about ready to do Ethan's surgery. We were concerned because Dr Milbrandt said he wanted it done before 8pm because Ethan is small and mistakes can be made after a long day...so we had the nurse page him to get his opinion and he said he wouldn't assemble a team at that hour, but if Dr Lumin had and was ready to do the line then he had to trust her decision to do it....not very comforting, but it is what it is....

Mistake #1 - the anesthesiologist came to talk to us and asked if Ethan was premature (which is was - born at 36 weeks) so they were going to need a monitored bed (ie needed to be in PICU where a nurse would be with him all the time) because he would be completely put out and intibated, as I mentioned before. So, they took a while but found a monitored bed for him. Great.

Mistake #2 - Dr Lumin came to speak to us in the Post-Op waiting room and said all went well and that they decided to sedate Ethan and do a local freezing instead of putting him out (which was a bit of a relief because anesthetic can be hard on the body and he's already been put out twice since birth). There are many posters in the room that state the surgeon may come out long before your child is ready to be seen because they are sleeping in the recovery room and need their rest and that the Recovery Team would call the phone in the room when the child is ready. We never got a call...we were freezing in this very uncomfortable room (Dale found the thermostat around 4am) and we were trying to sleep on the waiting room chairs (quite unsuccessfully). At 6am Dale went up to the ward where Ethan normally is and found our nurse to find out where our son was! She was so mad...we were forgotten about....she thought we were in PICU with Ethan, PICU thought we went home because we weren't in their waiting room, and the Recovery and Surgery teams were snug in their beds, without even thinking to check the waiting room before they left!

Mistake #3 & 4 - Ethan had his dressing changed 3 times in 18 hours because he was continuously bleeding....normally they don't touch the dressing for 24 hours so it has time to clot and start healing. At the 36 hour mark our nurse called in a favour from the NICU. The NICU nurse came down and when she took off the dressing (now for the 4th time) Ethan's skin opened up! The part that the doctor cut to find a vein was wide open! The last time Ethan had a central line Dr Milbrandt stitched that cut closed! It is possible that Dr Lumin put steri-strips on the cut and that PICU accidentally removed them when changing the dressing....but I don't know about that...I wonder if this was a complete oversight. The NICU nurse and the surgical resident covered wound with steri-strips and they also used a few to hold the line in place because is kept slipping out and kinking because the lock put on Ethan's knee isn't in the right place (mostly just because his leg is so little and it couldn't be put farther down). Then they covered it with aquacel to act as a pressure dressing and then 2 layers of plastic bandage to hold everything in place.

Mistake #5 - at about 1am I had a very strong feeling that I needed to change Ethan's diaper. He just barely woke up and probably would have settled with his soother, but I unwrapped him...and to my horror there was blood on his sleeper and his line was completely unattached! I immediately pressed the call bell. The nurse came in right away and I put the IV line connection in her hand! She didn't even really realize what was going on because this 'never' happens! Of course it doesn't....but it happens to this poor little baby that can't speak for himself when something feels wrong! She reattached the line and checked for air (which there was none). This happened because of the placement of part of the IV connection to the line...it sticks out past Ethan's knee and can't really be protected by clothing because we can't close his sleeper over it.

So that's our central line nightmare to date...hopefully that's the end of the problems! As of 10am Friday morning Ethan is being fed slowly and continuously through a tube in his nose, so he needs to be watched 24/7 so he doesn't pull it out because there is a risk the fluid could get into his lungs. And since Dale doesn't work this Saturday or Sunday we are taking turns watching him. If we weren't able to do this then there would be a 'sitter' in the room with me and Ethan just watching him all night...kind of weird, but it needs to be done...hopefully he'll be off the continuous feed by the end of the day on Sunday and will just be fed every hour and then have his tube capped off. So, all that being said, I've given Dale an extra hour of sleep and we need to do a shift change!

Goodnight for now...