Tuesday, May 15, 2012

Home but not so settled.

We are back in West Virginia and a ton has gone on since my last post. Sorry I have not posted earlier but we have been trying to get into our routine and have had a few trips to the hospital. Jake is doing great and is loving being home. His breathing is so quiet it is kind of Eerie.

Before I get into everything that has happened the past few days I need to give you that back story I promised a few posts ago. I mentioned something happened and cause a blood clot in his Jugular. Before I begin I have to say that what happened in NO WAY makes me think any less of CHOP. They are an amazing hospital and if it were not for their doctors Jake would not be here with us today. It doesn't matter how big or small the hospital, mistakes happen because people are human. That being said we had a few nurses who I hope to never see again. I told CHOP that we travel 9 hours to go there because we want the best and although the doctors and surgeons have all been amazing, nursing care is equally as important because they are the ones taking care of Jake and mistakes like this could have cost him his life. It is not acceptable and I have filed a formal complaint. Here is the story.

Sunday night (May 6th) Jacob's nurse wanted to change the dressing from his central line. When she took off the dressing I noticed that a suture came out. I asked her if she should let the fellow know but she said no there were two more holding it in and it was fine. She slapped a new dressing on and went on about her business. About an hour later I noticed Jake was active VERY agitated. He was arching and just did not seem like himself. I let his nurse know. She said he was due for his morphine and was probably just feeling agitated because of that. She gave him his dose of Morphine. He calmed down and went to sleep... I went to sleep.

Fast forward to the next morning.... 

I woke up at about 7am. I heard the nurse say "He had a great night" to my mother in law who just walked in. I sat up and said "Hi beautiful" like I always say to him when I first see him in the morning. As soon as I looked at him I could see that his chest was swollen. I ran over to the light switched and was shocked by how he looked. He had no neck. His chest, shoulder, back of his head, back and neck were swollen with fluid. I knew immediately that the central line had infiltrated because this was the third infiltrate he had within the past week. I yelled to the nurse that I needed an attending IMMEDIATELY. She said "Let me look at it". I quickly told her NO, I want an attending NOW! She brings back a resident. At this point I am furious. I told them I wanted an attending that second.

There are protocols in place so that things like this do not happen. Nurses are supposed to check IV and central lines every hour to make sure that if an infiltration occurs it is caught before it gets this far. Jacob only has half of a heart so to see all of that fluid sitting on his chest scared me to death. I don't think the nurse checked on him at all that night or she would have seen it or at least noticed his bed. They called IV team up to look at it and before I knew it I had about 20 people in the room. Anyone I saw that day got an earful. I talked to the attending at length about how I did not feel safe there or feel like Jake was being properly taken care of. I told her everything and refused to let the nurse change the sheets on his bed (She tried) until the attending and the rest of the PICU team saw it. They were very good at listening to me and apologized that I was not being listened to. They told me that it would not stop there and that they would be taking action and also setting up a meeting for the entire nursing staff to discuss what happened and educate them about the risks of infiltration. The IV team also did a report and I filed a formal report with the hospital.

Jake had no neck, his chest was swollen and so was his shoulder, neck , chin and head. 

Picture I took of his bedding. If you look at his pillow you can see it is soaked in fluid. 

One of the fellows Nicole was AMAZING. She literally kept me sane during everything. She had been there for the previous infiltration as well and was the one that had to put the emergency central line in because of that one. She was very upset that the nurse did not tell a doctor that the suture had come out. She also was furious that the nurses were not listening to me when I would tell them I knew something was wrong. They changed my nurse since I was NOT happy with the nurse I had that day and asked me who I wanted looking after him that night. Nicole ordered a ultrasound of the central line site immediately and thankfully she did because that is where they discovered the blood clot in the jugular. She let me know and they started him on the lovenox shots immediately. Lovenox basically thins the blood so that more clots do not form. This allows the body to naturally fight the clot that is in his jugular.

I of course was a crying mess that day. It never fails, I always get through surgery and a few weeks of recovery without crying. I go into survival mode but then something like this happens and I have so much anger and emotion that my body just snaps and all of the tears come out like opening a flood gate. At one point Nicole (The fellow who seriously I just loved) and the child life specialist were sitting on the floor with me as I am crying my eyes out. I started laughing telling them that all we were missing was a bottle of wine. Seriously it was like an episode of Grey's.

Nicole showed me the x-rays that were taken right after the infiltration and the one that was taken after the line was placed. When the nurse took off the dressing she pulled the line all the way up into his chin. This was why he was arching and aggravated an hour later, he felt it. Then she hooked him up to the saline drip because he was going to the O.R. for his bronche the next morning. The saline had been flowing into the tissue of his chin and started filling his chest, neck, back etc. This poor kid looked like the state puff marshmallow man. He couldn't even turn his neck.

So that was a horrible day to say the least. We were also dealing with getting him a new G-tube that didn't leak so he was being poked, getting ultrasounds, x-rays and had his bronche that day. He also needed access to get meds for his bronche but IV team said they would not be able to get anything since his veins had basically called it quits and refused to hold one. They had to have interventional radiology come up and place one using ultrasound guidence. Jake will be on the lovenox shots for at least 6 months to a year and possibly until his Fontan. He only has one Cath site left so we have to be sure it stays clear of clots. We will see Hemotology in 5 weeks when we go back to Philly for his follow up Bronche and they will do another ultrasound of the clot to see if it has gone down any. They will also re-check his lovenox levels. We just had blood work done today and his levels are perfect so he doesn't need more blood work until we are in Philly. After that we will go to Cincinnati every 2 months to get a bronche and to get ultrasounds to check the clot. I told the docs at the PICU that I wanted someone to make it clear to that nurse how her mistake will affect us for the next few years. I know it is "Calmer" at night but it is still the ICU and the kids need to be followed. I never left his side but I have to sleep sometime and should be able to feel safe with him in their care.

Ok so now to catch you up. His bronche went great and he had a swallow study done on Thursday May 10th. Unfortunatly that didn't go as well. Jake had issues with thin and necter thick liquids. The liquid was not aspirating but was penetrating. Basically instead of it flowing down the esophagus like it should it was bouncing over into the pocket above the vocal cords then back to the esophagus and going down. Jake's vocal cords are always open now because of the graft that is there to hold them open so he can breathe normally. But this makes him high risk for aspiration. Prior to the surgery the liquids never did that so this is new. The hope is that as his airway heals that this will go away. We will do a repeat swallow study in 5 weeks when we are in Philly. But until then Jake is back on g-tube feeds. He is allowed to have as many purees as he wants. This consists of food like applesauce, yogurt, oatmeal, anything mushy or of that consistency. Thankfully there are tons of different packets available these days of all natural purees so we got lots of snacks for him. He can also have Honey Thick liquids up to two times a day. Basically it is any drink but I put a packet of Simply Thick into it which makes it the consistency of a milk shake. I have to work with him and only do a sip at a time. The rest of his nutrition is pediasure through his g-tube.

It has been hard for him. As soon as we got home he ran over to his cookie drawer. Andy moved them and he just stared into the drawer signing cookie and looking so sad. He doesn't understand why he can't have the foods that he loves. We are being creative and trying to chop, puree things he likes for him as a treat but it's not the same. It was strange getting used to doing all tube feeds again but hopefully it won't be for long.

He is still weening off of his Valium but doing well. I should be done with that by tomorrow. He is also doing great with his shots. This morning he didn't cry at all when I gave it to him. I guess I am also getting better at sneaking up on him. It is my mad ninja skills as Aidan would say lol.

We were discharged on Friday May 11th. That night I saw some puss coming from his central line site. Andy was flying in from WV to get us so as soon as he got there we went back to the ER to get it checked out. 3 hours in the ER and we found out it was not infected, he just scratched it. They gave us mupriacin ointment to help protect it and off we went back to the Ronald McDonald House. We drove home Saturday and Jake did great! I enjoyed Mother's day at home with my boys and couldn't have asked for a better gift.

Yesterday I was giving Jake a bath and felt something hard on the back of his head. I looked and saw a huge spot that looked like a blood clot. I immediately called his doctor worried it could be bleeding and since he is on blood thinners I worried something was wrong. The good thing was neurologically he has been great. He has been walking and even climbing since we got home and he was acting normal. Of course right before i saw it I sent Andy to Walmart for Pediasure so I had no car (Seriously need another car because I was stuck with no way to get to the hospital). I called my sister who picked up the boys and I and off to the ER we went... AGAIN!

GIant black blister. The skin is burnt and dead from the infiltration.

We checked in and after trying to convice the registration people that 77 was a correct pulse ox read and normal for him we waited to be called back. As I was sitting in the waiting room it dawned on me what it was. I remembered baby Mia's arm when she had an infiltrate. It had a huge black blister on it. I ran to find the nurse and let them know that I thought I knew what it was. We saw the doc and I was right, it was a huge blister from the infiltrate.

As I look back at pictures I took him the day of the infiltrate I can see red under his hair in that exact spot. I assume that there was so much fluid and he was laying on that spot so it blistered or maybe even popped but no one saw it. You can't see it under his hair so if I had not felt it and looked we wouldn't have known it was there.

If you look closely you can see red in the same spot the blister is now in.
This picture was taken right after I found the infiltration. 

It is red around the blister so they put him on Clendamyacin just in case the skin is or is getting infected. We saw his doctor today and she said it looks like the skin is pink from healing and she doubts it is MRSA. He has no fever or puss. The antibiotics may even be overboard but because of his history and just being in the hospital it is better to be safe than risk something else happening. So he will be on them for about 10 days. The last time he was on this medication (when he had the sternal infection) and on tube feeds, he got C-diff (Another type of infection). So I am praying it doesn't cause that again. He will most likely lose his hair in that spot when the new skin starts forming and the blister falls off.

Sorry for such a long post but as you can see we are home but it has still been very hectic. Thankfully Jake is doing great! He is very happy to be home and we are all adjusting to the new med and feeding schedule. We will be heading back to Philly in about 5 weeks. Please pray that we can stay OUT of hospitals until then.

Heart Hugs!


Wednesday, May 9, 2012

Another day in the PICU...

Today was a really good day for Jake. We took a wagon ride around the PICU and he was so happy to get out of his room. He laughed so much, it was great to see him so happy.

He was pretty tired most of the day because he worked so hard during PT, OT and Speech. He walked a tiny bit. Even just sitting up and trying to crawl is very hard for him right now. His muscles have decompensated from being in bed for two weeks. It will take time to get him back to normal but I know it will be easier once he is in his home environment and not attached to cords. He has started sleeping with his bottom in the air again which is great to see because this is how he sleeps at home.

They did an ultrasound last night of the clot in Jacob's neck. It has not gotten any worse. They also scanned his groin cath sites and said they looked good. 2 years ago they were occluded and not able to be used. Jacob's cardiologist came by today and I mentioned it to her but she said that even though it looks ok on the ultrasound that doesn't mean its ok. They could still not be able to get through so they can try next time he has a cath but they won't know for sure unless they go in and try.

I had the Lovenox training today. Lovenox is the medication Jacob will get twice a day. I have to give it by injection so I had to have training before we were able to be discharged. It went well. Right now they are using a inceflan catheter (not sure of spelling) that stays in his leg and they put the shot into that he doesn't feel it. The problem is you have to line up the needle perfectly and he has to be held down longer. They also are not usually covered by insurance and cost a lot. Jake HATES to be held down even for a minute. He has major anxiety, understandably. The needles I will get for these shots are TEENY TINY. They are diabetic needles. I think it would be more painful for him to have the catheter inserted even if it is every 5 days. I think he would be better off if I just did the shots daily. It will only take a second so by the time I put the shot in he won't even realize what happened (Hopefully). Plus I can alternate where I give the shot each time so he won't bruise. I can give the shots on the thighs, back of his arms, butt or stomach. I will most likely use the legs the most. So while I still hate that I have to give him these shots I feel comfortable with doing it. 

Needle that we will be using for Jacob's shots.   
They tried to get labs twice today to check and see if Jacob's lovenox dose is at a theraputic level. Both times it didn't work. Jacob's veins are just so bad they won't give enough blood. Tomorrow they are going to try to get it from an artery in his wrist. They have to see if he is at a good level. We don't want him to be able to bleed out but we also don't want him to clot so it is a fine balance. If he is not at a perfect level they will have to adjust the dose and check again. They HAVE to do the test 4 hours after the injection so there is a small window of opportunity. Praying they get it tomorrow so they can write his scripts and not hold up our discharge.

Jacob worked with speech again today and had a little bit more trouble. He is a crammer with his food so we had to give him tiny bites or he would swallow and cough instead of chewing it up. We are going to have to work with him on getting him to chew more instead of shoveling it in as fast as he can. He also had a little trouble with the chocolate milk so we may have to thicken his liquids for a while until he gets used to the new airway. I will learn more tomorrow because he will be having a swallow study that will show us what it looks like as its going down the airway and how we need to proceed. Most likely I will have to use the g-tube some to help supplement with pediasure until he is back to his normal eating.

Working hard on eating.
Jake will also have a heart echo tomorrow. The docs plan on getting his prescriptions sent to the pharmacy for me so on Friday all we will have to do is rounds then DISCHARGE! We will take Jake to the Ronald McDonald House for the night and Andy is flying in that evening. Then we are going to rent a car and drive back home on Saturday morning. HOME... oh how I miss home. I can't wait for our family to be under the same roof again. I can't wait for Jacob to feel safe again and not cringe and cry everytime he sees someone come into our room. I can't wait to see Aidan and have my cuddlebug back. Please pray all goes well tomorrow and we can be discharged as planned.

Thank you as always for the prayers. 


Tuesday, May 8, 2012

Home is in sight...

I have a lot to write about but for now I just want to give a very quick update. Jacob is doing well. We had a bad day yesterday and he now has a blood clot in his jugular vein. He will need to have Lovenox shots twice a day to help prevent the clot from getting worse and help the body naturally dissolve it. We will also need to go to Cincinnati every few months to have ultrasounds done of the clot to see if it is going away.

I will go into more detail over that later but for now we are grateful that Jacob is ok and moving forward with his treatment and recovery. We were told a long time ago that his groin cath sites were occluded but he had an ultrasound tonight to check the sites and there is a chance they are now healed and can be used for future caths. I will find out for sure tomorrow during rounds.

Jake showing off his coloring skills.

Jake had his bronche yesterday and his airway looks beautiful. ENT actually discharged him from their service. We are working with Speech and today he ate a container of applesauce and drank some Chocolate milk. He didn't seem to have any problems. He actually was not happy with how quickly the therapist was shoveling it in and grabbed the spoon to feed himself lol. Tomorrow we will take him off continuous feeds and get on  more of a "Normal" schedule. I will probably have to supplement through his tube with pediasure for a while. He got a brand new g-tube yesterday as well.

If I sit real still and put this bucket on my head maybe they won't know I'm here.

They cut his morphine in half today and will stop it completely tomorrow. He will go home on valium but I will have a weening schedule so he won't go through withdrawal. Tomorrow I will have a training class about giving him the injections he will need daily for his clot. Thursday he will have a swallow study to make sure that he is still not having any issues with food.

Friday we will be discharged! We are going to the Ronald McDonald House and leaving to drive home Saturday Morning.

I will write a bunch more later but didn't want to leave Jake's fans hanging. Thank you so much for all of the prayers. My little fighter is doing very well! AND HE IS SO QUIET!!!!!

Thank you for the Puzzles Bennett Family they have really kept me busy!


Saturday, May 5, 2012

Baby Steps...

I am pretty tired so this is going to be short and sweet. It has been a long day. Jacob is doing well and progressing but has been pretty sad today. He has been sticking his lip out looking like he is going to cry then waving bye-bye. He is ready to bust out of this joint, I don't blame him.

We made good progress today. His morphine was weened from 8 times a day to 6. He successfully came off the high flow oxygen to the normal nasal cannula which means he can begin to learn to eat by mouth yay!!!! Speech is supposed to come tomorrow to work with him and give us the OK.

PT and OT came by and are going to come daily while we are here. He took 3 steps today which is great! He is getting his strength back. I notice a huge difference in that. He is able to sit up and hold himself up without shaking.

We replaced his g-tube (Twice). The first one the nurse put in was WAY to long and stuck way out. I told her the correct size but the system had something else. I called my husband to grab our extra at home and double check and the size I gave was correct. She then said she didn't know why formula wasn't coming back out and wanted to put dye in there and get x-rays to make sure the tube is far enough down. I told her that since he had not had food in an hour and before that was only on 45ml/hour the food would be digested by then so that is why formula isn't coming back up. But I humored her and agreed to the x-ray. Guess what, it was fine.

I have to chuckle because the day before I was worried that Jake was way too puffy. I told the docs I thought he needed lasix and everyone told me no he is not positive on his fluid balance so we don't think he needs it. The next morning I came in and the nurse told me "The doctors thought he needed lasix so we are giving him a few doses today". Uhm hmmm that sounds familiar lol. I know my boy.

So overall he is doing great. His spirits are down but he is making a lot of progress. Hopefully the Bronche looks great on Monday and we can blow this town. We will have to come back in a month for another Bronche but at least we can go home for a little while.

Thanks as always for keeping my beautiful boy in your thoughts and prayers. It is hard watching him so sad and defeated but I know he is making progress and we will be home playing soon.


Friday, May 4, 2012


I know that I already blogged today but I had to post this amazing video. Jake just keeps getting better and better. He was playing all day. Tonight I asked if he wanted to watch baby signing times and he clapped. I put it on and he smiled. And then the best thing ever happened.... He started cracking up.

God how I missed this.


Feeling Better!

Jacob had a rough night and was up most of the night having withdrawal symptoms. THey had to increase his oxygen overnight to help him since his body was having withdrawal but have been slowly decreasing it and weening him today.

He is going to have a scope on Monday. They are checking to make sure there is no swelling in his airway since removing his vent. If there is they would just put him on steroids but they said he looks and sounds great so they don't anticipate seeing anything. This will also allow them to come up with an aftercare plan. We will most likely have to come back in a month for another scope and then another at 3 months. He will need a 6 month scope but we hope to be able to do that one in Cincinnati since it is closer.

As far as this stay we just have to ween his oxygen and some of the meds and work on eating by mouth. We haven't been able to consult with speech yet because he is on high flow oxygen. As soon as they can get him to the regular nasal canula then he can start working on feeding. Right now he is  getting continuous feeds of Pediasure through his g-tube. He will most likely go home on Valium and Morphine so I need to get a weening schedule for him and may have to get at home nursing. They told me I may need it because he will still a lot of work to take care of him. I kind of chuckled and told them he has always been a complex baby and this will be nothing compared to coming home post Norwood. He was on 8 meds, oxygen, pulse ox, continuous feeds, gtube issues and doctors appointments daily. I don't like having to ween him off meds and deal with withdrawal however I will get a schedule from them and learn just as I have everything else. You kind of become a nurse when you have a hypoplast so I have learned to adapt and do what it takes to keep him healthy.

Reading his book!
Jake has been so much better today. He is still puffy but he is so much more alert. He has been fighting the nurses more which is a good sign and is playing with his toys! He has been doing puzzles and loves flipping through his book. He is even pointing at the pictures and pushing the button that says what it is. He wasn't even doing that before surgery. I think his hearing is probably so much better now that he doesn't have his noisy breathing blocking the sound.

Aidan, Andy and my mom left today. It was so hard saying good-bye to them. Aidan cried and it broke my heart watching how sad he was. My mother-in-law is here with me helping me out. Hopefully we will be able to go home in a week or so and we can all be together as a family.

Thank you for the continued prayers, they are working!


Thursday, May 3, 2012

Road to recovery...

Hanging in there...

It was a rough night but Jake has been having a better day. He started having severe withdrawal last night and was shaking really bad and vomiting about 5 times an hour. I was very scared because he looked so bad. It is not uncommon because he was on a ton of medications and then they had to turn it all off to get him awake enough to extubate. They put the dex drip back on to help transition him and increased his valium that he was getting through his g-tube. They also gave him some rescue meds to help catch him up. It worked and he slowly started shaking less and has not vomited since last night. 

They had to put him on high flow oxygen to help since his oxygen SATs took a hit with how sick he got but we have been able to slowly ween that down today and will hopefully be going to the regular nasal canula. They are about to turn off the Dex IV drip as well so please pray he doesn't have any more withdrawal from that. It is so hard to watch him suffer and not be able to help him. 

Holding our sweet boy after extubation.

Everyone is very happy with his progress and there is even talk about sending us to the step down floor this weekend. He was not able to eat for a while because of his vomiting so speech could not come today. If he is successful at coming off of the high flow oxygen then they can start working on him eating by mouth. 

There was talk of us going home next week but we are going to see how it goes. His surgeon had said she wanted to do another bronche on Monday but today they said two weeks. I told them that we can't go home and come back a week later. It would be too much on Jake. So they are going to see if we can just go home and come back in a month for his bronche. Again we still have a lot to do before we can think about "Home" but it is being brought up. 

Andy, my mom and Aidan are going home tomorrow. If we knew for sure Jake could come home Monday they would stay and we would just go back together but since we have no way of knowing they need to get back. So we are going to play it day by day and if we get discharged before next weekend we may stay in the city for a few days and figure out a good time for Andy to come get us. 

Overall Jacob is doing really well. He has been alert and clapping and even playing some. He LOVES his beads of courage. As soon as I showed him he grabbed them and has even sat up to reach them. He got more beads today for everything he has been through over the past week. 

We have been holding him a lot today and giving him lots of love. We had a beautiful moment today as Aidan was able to sit and tell Jacob how much he loved him. Jacob kept feeling Aidan's face. Aidan told Jake that he was the best brother he could ever have. I am so blessed!

Brotherly Love

Me and my boys. Jake looks so sad.
Snuggling with Mimi.
Loving on Grandma.
Bubbles with Daddy!
Such a good big brother.
Aidan hanging with the grandma's.


Wednesday, May 2, 2012


Jacob was extubated and as you can see he was very happy about it! He is still shaky from the sedation but is doing well weening off of it. We put him on the nasal canula to help out a bit while he is still fighting sedation.

We still have a long way to go but today was a big milestone in Jacob's recovery. I am so proud of my amazing little fighter. To the moon and back baby, I love you.


Tuesday, May 1, 2012

Where do I begin?

So much has happened since last night and I have had about 3 hours of sleep so I hope I can explain it all clearly. First here is the picture I promised of me and my fellow heart moms...

Now for the madness... 

Last night Jacob's was waking up. I noticed he was opening his eyes a lot and seemed to be waking up. I told the night nurse and she gave him three rescues. He was still waking up and I continued to tell her that it was not normal for him and he should be out. I then felt the bed by his IV and it was wet. His IV that he was getting his continuous sedation from was leaking. I had her call in the fellow to look at it and they all thought it was flushing fine so it was good and to just keep an eye on it. I continued to worry about it and asked them to move his sedation meds to his other hand with the IV that was working. At this point he had not been getting his meds for at least an hour. Thank God I found it when I did. They moved the saline drip to the questionable IV and I noticed it was increasingly wet. I insisted that they call the IV Team. IV came and looked at it and unwrapped his IV board and immediately saw that it was leaking and infiltrating his skin, it needed to be removed. They called up another IV specialist to see if they could get another one in since he was down to one working IV. They came up but were unable to get one. After two tries of his eyes open and crying I told her to stop. It broke my heart seeing tears run down his face and him awake with all of this going on. Little did I know it would get worse.

So it was about 2 or 3 in the morning and I was afraid to sleep knowing that had I not found that IV he may have been much worse. I have loved all of his nurses until last nights. She just sat around and didn't seem concerned about anything. I had to insist on getting the fellow or iv team because she just acted like she didn't want to do anything. She had a very quiet personality and was nice but I just didn't trust that she would care for him. I finally gave into the exhaustion and told her that I would like her to spend extra attention to that IV since it was his only one.

I woke up at 7 as the ENT team was taking Jake down for his scope. I walked down with them and said good-bye to Jake and went to the 4th floor waiting room. The scope went by very quickly and we spoke to the ENT doc. Everything went well and his airway looked beautiful. The plan is to extubate tomorrow.

When we got back to the PICU all hell broke loose. I found out that after I went to sleep apparently the other IV went bad and was infultrating. The nurse who is supposed to check it every hour must not have because his arm was hard and cold all the way up to his shoulder. It infultrated into his tissue. To say I was furious was an understatement. His hand looked like a balloon. It was hard as a rock. Thank God they found it when they did or he could have needed surgery or worse. Thankfully his blood flow is ok and his tissue is ok so there is no permenant damage. The swelling has already started to come down.

I asked to speak with the charge nurse and told her how upset I was. I mean if it were just the first one yeah I get it, it happens. But the fact of the matter is that it is supposed to be checked hourly and the first one was only found because I was paying attention and found it. She thought it was fine and was going to leave it. I had to push and insist. Then when I finally go to sleep because it I can't stand any longer and it is her job to take care of my son, this happens. He had to go through a ton of pain and discomfort because of it and could have lost his arm had it been a different drug or gone on longer. It is unexcusable. So IV team came and took pictures and filed a report. The nurse will be spoken to as will the entire floor about safety and this type of thing.

My nurse today who was great and came into a crazy situation luckily kept a close eye on the new IV they put in while in the OR. That one was on the hand that previously infiltrated the night before. She noticed that IV was starting to look puffy and immediately told the fellow who happened to be right there talking to me about how she worried he would lose that one and not have access and thought he should have a Central Line. No sooner did she explain it to me did his last IV blow and they needed to put in an immediate central line. Poor baby was alert, not getting meds and no access.They were able to get his IV to work enough to get the paralytic in. They had to go in his jugular because his groin was occluded from his previous caths.

They got the central line in but the xray showed it was too close to his Glenn and wanted to make sure it did not affect his pulmonary artery because he will have more open heart surgery. They put in a smaller line which was easier since it was already in they just had to re-thread it. Jacob was pissed to say the least. He was shaking from the paralytic wearing off and he had not been getting meds so he was waking up. His heart rate was up to 170 and that was after getting a ton of sedatives. His pressures were also high for a while but he finally calmed down and has been resting for the last few hours.

The good news is that the scope showed a beautiful airway and he can be extubated tomorrow. He has also done very well with weening off of the vent. As of now he is on extubatable settings. He is breathing over the vent and I am very hopeful to a easy extubation tomorrow. Tonight we are going to try and keep his sedation pretty much the same because we don't want to rock the boat and risk him getting upset and having to go up on vent settings. Tomorrow morning they are going to cut down on his meds and then extubate.

We will then work on weening him off of the rest of the meds and start working on speech issues. He will have to learn to eat and use his airway again. If all continues to go well they will do another scope on Monday or Tuesday and if things look good we can talk about coming home. If we do come home we will have to be back in another month for another scope... but can't even think about that right now.

SO.... LONG DAY, STRESSFUL DAY, Jake is finally resting and please join me in praying for a peaceful night and easy extubation tomorrow.

Oh and a HUGE thank you to our roomate. She has been so helpful the past few days especially today while dealing with all of this. Her precious baby girl is thankfully well enough to go home soon and they went to the step down unit today. I must admit when I heard a baby was coming in our room I was nervous but she was so sweet and so good! We will miss you guys. Good luck, so glad you are busting out of here soon!