PICC line shenanigans

David arrived Friday evening for a much anticipated 10 day Thanksgiving vacation at the stately Chateau Egleston.  We were able to sneak out of the hospital for a late dinner at a nearby Chili's (thank you Katie Anguish for the thoughtful gift card!) and enjoyed a nice beginning to David's stay with us.  Then we arrived back in the NICU to a stomach clenching, but familiar sight - a hubbub of activity outside Joshua's room and the mobile x ray machine being rolled in.  What in the hell is going on now?  He was fine when we left less than two hours ago!  Unfortunately, we have been through this situation multiple times before so it was a very unpleasant deja vu for us.  Our nurse stopped us outside the room and explained there was concern Josh had a PICC line infection called phlebitis because the skin surrounding the PICC line insertion was red and irritated and a nodule had formed at the insertion site.  She had a very serious look on her face as she spoke to us and I knew an infection in the PICC line vein is a very dangerous thing since the PICC line is threaded all the way to his heart.  On top of this, she told us Josh was already on the antibiotic that would be prescribed for phlebitis.  This was extremely alarming news to me since the antibiotic that should work obviously was not preventing the infection from forming, if it really was an infection.  So what would we do if it was phlebitis and vancomycin was not effective against it?  Our nurse did not have an answer and panic started setting in. David took the news especially hard and had to sit down at the nurses desk before he passed out.  I rushed in to check on Joshua as two of our nurses took care of David getting him an apple juice and an ice pack for his neck.  He recovered quickly and we tackled this latest obstacle. 

Josh had to have the PICC line redressed three days in a row starting on Wednesday which is a very unusual circumstance.  Typically a PICC line dressing lasts at least a week and sometimes several weeks before redressing is necessary.  Josh has very sensitive skin and I suspected all the dressing changes which require pulling up on sticky steri strips and tegaderm irritated Josh's skin.  His heart rate, temperature, and temperament were normal.  Placement of the PICC line is almost just as important as keeping it infection free since only proper placement insures Josh is receiving his nutrition and medicines.  The PICC line had continued to inch out with every dressing change so now the placement was in question, too.  It was looking like Josh was going to need a new PICC line which is a bit of a production.  We ended up sticking it out until Sunday morning then there was blood coming out of the insertion site under the dressing and the day got really interesting.  A pediatric PICC nurse was brought to put in a bigger, stronger pediatric PICC line.  I discussed with the PICC nurse which option: scalp, arm, or leg made the most sense for Josh's new line.  Arm was her preference since the vein was big and easily accessible.  I was either for another scalp since this seemed to stay out of the way or leg since then at least we would still be able to fully dress him.  With the PICC line in his arm, we are not able to get his sleeve on and off that arm.  In the end, it wasn't really my decision so when we were allowed back in the room a few hours later, Josh had a new pediatric PICC line in his right arm.

Sporting my new PICC line and a bandage over my old insertion site.

The old scalp PICC line was pulled after confirmation that the new line was properly placed.  We are still getting used to handling Josh with the arm PICC instead of the scalp PICC.  It is a much sturdier line so you don't have to be as worried about how fragile it is.  A big downside is the fact that he has to wear his clothes with his right arm out.  Know anyone that makes baby togas? 

Watching the UGA game in my new jersey on Saturday before the PICC line shenanigans.

In very positive news, Josh's wound seems to be healing nicely and he was finally pulled off the antibiotics after the fear about the phlebitis infection subsided.  He is currently taking 40 cc of milk every 3 hours and we are hoping for 45 cc tomorrow.  Joshua is a big growing boy up to 11 lbs 10 oz and over 24" long.  He is talking up a storm and really showing his adorable personality. 

Our favorite doctor, who happens to be the head of the whole NICU, is working this week (she has been off the rest of November).  I am hoping to corner her to pepper her with questions and what if scenarios in an attempt to figure out when Josh might possibly be allowed out of here.  Is there any chance we could make it home by Christmas?  Please, please, please, please let it be so!!!!

Josh hamming it up for the camera during his bath last night.  Our nurses gave him his first mohawk!