Last night the domino effect was fully in place. All went well in my preparations to start Susan's TPN. We got to the very last step where I'm supposed to flush her port line with 10cc of saline solution. I attach the syringe, push on the plungger and nothing happens. I make sure that her clamp is in the off position and try again. The back pressure against my thumb is high, but I manage to slowly push 3 cc in. Then Susan complains "it's burning." So I call Bob the nurse and he asks me to try a few other workarounds to no avail. "I'll be there in half an hour," he says. Thirty minutes later he arrives, finds the same problem and concludes that somehow the needle that goes into her port has dislodged. He takes out the needle and replaces it with another one--a fairly involved process which was scheduled to happen today anyway. (Port accesses are only good for one week.) We get her all hooked up again to the TPN, and then as part of his process he takes her pulse and blood pressure. Conclusion: pulse is very high, and blood pressue is very low. He rechecks. Same answer. "I'm required to call the doctor if the BP drops this low." He does. The doc says, "go to the ER and get it checked out."
Fully expecting her to be admitted, we pack a few things and head down to the now familiar Med City ER. After the usual tests, doctor conferences, etc. it's concluded that she was dehydrated--despite the TPN--and her hemoglobin is way down. Dr. Savin is called and he indicates that she probably needs some more units of blood, but gives us the option of going home and getting them during daylight hours. In the meantime the liter of fluids they were giving her while we were waiting for the diagnosis brought her BP up and her pulse down. They release us, we head home and start the TPN at 1 AM. At 7:30 AM we are awakened by a phone call from Cheryl, the other home health care nurse who wants to know what's going on. She has to be rescheduled because the TPN won't be done until 1 PM. So as I write this, we are waiting for the TPN to be finished, for Cheryl to come, and for Savin's office to get back to us about scheduling the transfusions. I'll try to keep you posted as best I can in my sleep deprived state....(Yawn).
Posted by John Dishman at June 25, 2003 11:03 AM