Day 18

This afternoon Samuel was rolled down to radiology. He had a PICC line (peripherally inserted central catheter) placed in his left arm while under sedation. This PICC line will replace the two IVs that he has had in his right arm. These regular peripheral IV sites often become sore and irritated and have to be replaced every few days. Samuel has been keeping track of how many IVs he has had placed. He is sleeping at the moment (thankfully!) or I would ask him for the tally.

Externally, Samuel's PICC line has two lumens (lines) with a clave at each end where the IV lines or a syringe can be connected. Internally, the two lumens lie side by side within one catheter, which runs up a vein in his arm and into his chest, ending a little before the heart. This PICC line will be able to remain in place much longer than a peripheral IV. It can also be used for drawing blood which will spare Samuel being stuck each morning. To reduce the risk of infection, Samuel has a gauze bandage wrapped around his arm where the catheter enters. Overall, this new PICC line will provide better access and be much more comfortable for Samuel.

While Samuel's arm is happy, his back is not. Part two of today's procedure involved placing another drain through Samuel's back into the space where his right kidney used to be....his right renal fossa. (I recommend that you try impressing your friends and neighbors by using the term "renal fossa". It is fun to say and they will likely not have a clue what you are talking about.)

The ultrasound and CT scan that were done yesterday showed a reaccumulation of fluid in the same place where a drain had been placed on Christmas Eve. That drain was removed on January 3rd.

Before placing the new drain, Samuel was rolled onto his stomach and a small group of interested parties gathered to examine the area using ultrasound. I'm told there was some debating, discussing, and general head scratching as they tried to determine what they were looking at. Was it infection? Was it bowel? Was it Surgicel (http://en.wikipedia.org/wiki/Surgicel) left over from the last nephrectomy? It seems the answer was yes, yes, and yes.

At some point in the procedure, Samuel went from being sedated to being under general anesthesia. Guided by ultrasound, a needle was inserted into the area of suspected infection and some fluid was aspirated. It appeared to be pus and was sent off to the lab to be cultured. Hopefully, something will grow out of it and be identified so the infection can be targeted specifically, rather than being treated with broad spectrum antibiotics.

The JP drain (http://en.wikipedia.org/wiki/Jackson-Pratt_drain) was placed, secured with a couple little stitches and thoroughly bandaged. Any and all drainage is collected in a grenade-shaped bulb at the external end of the tubing. The bulb is uncapped, squeezed flat, and recapped. This creates a gentle vacuum effect which draws fluid down the tubing and into the drain. The whole set-up will be flushed multiple times a day in hopes of disrupting and dislodging any infection.

During the procedure, I had to sit out in the hallway and miss out on all the excitement. Dr. Di Carlo was very kind and came out several times to give me a play-by-play. By the way, I will now only be able to say nice things about Dr. Di Carlo and Dr. Guillot, as it seems they have taken to reading my blog. I'm both honored and intimidated!

Samuel went from radiology up to the PACU (post anesthesia care unit....a fancy name for the recovery room) where he woke up, received some pain medication, and went back to sleep. After a bit, he was rolled back up to his room in pediatrics.

This evening the lab results from the antinuclear antigen test confirmed that Samuel is not suffering from drug-induced lupus....a possible side effect of one of his blood pressure medications. Praise God!! The doctors feel confident that the recent decline in Samuel's condition can be attributed to the flair up of the infection. However, the cause of the infection and the reason for its reappearance remain a mystery for the time being. The expectation is that Samuel will start feeling better soon!