Coming off of ECMO

Dr. Anderson stopped by this morning, and after looking at his numbers during the trial off, he has decided that he is stable enough to be taken off of ECMO. This will include takingnhim off of dialysis. When he removes the canulas, he will attempt to put a venous central line in the vein at that point. This may or may not work to give them access for dialysis. He will not be on dialysis for a couple of days in which we hope that he will urinate. If he does not, he will have to be put back on dialysis. In which, finding access is an issue. They can use a vein in his chest or groin, both of which are not quite as big as they would like them. Hopefully the venous central line will stick in there and they can use that if they do need to put him back on dialysis.

They are planning on pulling the canulas between eleven and two. It will be a couple of hour procedure.

Update from Dr. Anderson

Dr. Anderson, the surgeon involved mainly with Memphis' recovery, stopped by and gave us a little update about what they have planned with his trial off. They are all very hopeful due to his numbers being so low for the last day. He has ordered the ventilator to be turned up. All this means is that he would like Mempis to be supported by the ventilator rather than the ECMO pump. One major issue with all of this effort is the dialysis pump. When coming off of dialysis, they need the kidneys to take back over and start producing urine. The urologist is stating that she is not confident that his will start back. This is not to say that they will or will not, but they aren't that hopeful as of right now. The easy solution to this would normally be keep him on dialysis. Unfortunately, this is not that easy. The dialysis pump typically uses the right side jugular vein for access on babies. Due to being on ECMO, especially for the length of time he has been on it, this vein is inaccessible. They can put access on his left side, but then all of the main venous flow from his head would be blocked, which would cause issues with blood flow and hemorrhaging in the brain. Which all are not risks they seem to take lightly, I wouldn't either. The other solution on a healthy baby is to diurese through a port in the stomach. This would be acceptable if he didn't have the hernia. This increases fluid in the chest, so they can't do it. It really seems that if he doesn't start producing urine, they are at a stalemate between his body and the pump.

His pump as of right now is down to .18, gas is .3, and o2 is 80%. the ventilator setting has been set at a rate of 40(up from 20), the o2 concentration is 60% (up from 40%).

Let's hope for some great urine output!

New goals

Memphis' stats are all about the same that they have been for a few days now. Everything looks hopeful in the idea of getting him off of this machine. They started dopamine yesterday to bring up his blood pressure. Today they are starting two different medicines, steroids and lasixs. The steroids are to help him recover more and be stronger for the possible trial off. The lasixs are to help him urinate. They want him to have a little bit of urine output before they remove him from dialysis.

He gained 110 grams last night. So let's hope for some weight loss, and some pee.

Just a quick update

Memphis had a new PICC line put in today. It goes in at the base of his big toe on his left foot. Basically he has a tube that runs from his big toe into his heart now. That's crazy. Everything went fine and he is recovering now (which is basically no different than what he does the rest of the day.

He had his eyes (yep both of them) wide open when we got here after lunch. They were both so big and clear, compared to the usual fuzzy and sedated look he normally has. I think he may be trying to smile a little. It's hard to say with all of the tape around his mouth, but maybe he is.

That's it. Just a quick update.

A slight setback

Last evenings pump change has brought some repercussions with it. He has gained 530 grams. This may be from the difficulty they had yesterday at keeping the dialysis pump running. His blood pressure was floating around a mean in the twenties. They try to keep this number somewhere around a mean of fifty. This has been a long running issue with dialysis, and something that is expected, but I think they weren't expecting this much of an issue with it. They have increased his ECMO flow to .460 due to this. They can control his blood pressure somewhat through the pump, but this is counter productive. His x-ray has shown some more "whiting out", meaning that there is less oxygen in his lungs. This a typical response from the pump circuit change out. They are planning on starting him on steroids as of tomorrow. All of these things are the "tricks" that the doctor had ready for Memphis when he was taken off of ECMO.

With all of this, his co2 sweep is still at .3. This means that his body is ventilating the carbon dioxide somehow. Even if his lungs are less open.

This issues will be hopefully resolved within the day, and it will be just like taking a day off of recovery.

A new pump

His pump change went great. They didn't have to paralyze him for it, just gave him his normal pain medicine. They also changed out his dialysis machine. They turned up the oxygen on the ECMO pump, not because they had to, but because if he needed the extra support they wouldn't have to try and catch up with him.

A quick update

They are planning the pump changeout at around 2:00 pm. This is also the time that they close the NICU for shift change. Along with changing our circuit they are also changing our neighbor's circuit. Rarely do you see the NICU this congested with nurses.

Let's hope all goes well and I will keep you guys updated.