Sunday Update - August 10, 2008

I wish I felt as positive today as I did yesterday.  I think I hit the wall maybe.  First of all when I came back from a pumping session Griffin's nurse told me that his scalp IV wasn't flushing very well, and she was considering taking it out and looking for a new site.  In adults I know it is protocol to remove a peripheral IV after 3 days to decrease the risk of phlebitis, etc., but in the NICU we keep PIV's as long as we can b/c IV access is so much more difficult in these little babies.  The NICU Attending for today told me he feels very strongly that G will need a PICC line to complete his course of antibiotics.  If all goes well and Griff remains afebrile with negative cultures, the earliest a 14 day course in-house would get him out is August 21st.  Two different ID attendings recommend a full 14 day course of in-house IV antibiotics, and today's NICU Attending strongly agrees that that is the safest course of action.  Until today I would have agreed, but now I just want him out of the NICU and home.  There will be a different ID Attending rounding this week and if anyone would be more amenable to a shorter in-house course and home on possible p.o. (oral) abx, it would be this doc.  True he is somewhat of a "cowboy," but he is also extremely smart and well-read so I may be inclined to go with his rec -- provided that is what he indeed thinks is the best course of action.  He might very well say G is too little and the infection is too serious (S. aureus can be very nasty) to do anything less than a 14 day course of IV.  Which brings me back to the reason I feel less hopeful today -- we are faced with the same problem, namely, how to get multiple days of IV antibiotics into a baby with tenuous IV access.  A PICC line scares me to death, and that's not half as much as a broviac or cut-down scares me -- all of which are things being considered in terms of how to deal with Griff's "issue."  The whole reason we are in this situation is b/c of the original line (UVC) that was placed and got infected, and I feel like giving him a new line is just opening him up for another nosocomial infection (infection acquired as a result of medical intervention).  As I was holding Griffin today and looking at his beautiful face, I just wanted to pull out his scalp IV and take him home.  

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I took a break from blogging to wash some clothes and then called the NICU to check on Griffin and his nurse said he is acting very fussy, which is unusual for him b/c he is usually a very happy little guy.  And that says a lot about his disposition seeing as he has been poked and prodded so much.  I am hoping it is just b/c he is uncomfortable from the bleeding diaper rash he has (yes, the kid cannot catch a break!) and not from a new infection brewing or another fever about to rear its ugly head.  PLEASE keep Griffin in your thoughts and prayers.

-Sheila