ChloeWatts.com

Friday, February 12, 2010

Hang onto your hat, I’m about to write the blog, and it’s not going to be something you’d expect. Chloe asked for cough assist tonight for the first time since the Feb 3rd incident! So I was all poised to make sure everything went perfect. RT Jessica W. showed up and assessed the situation. She asked the right questions, listened to the answers, had zero EGO and performed to my high expectations. I had to let her know how much I appreciated her professionalism and told her it was a very rare thing lately.

Last night was one of those regular RT times. The new trach was filled with air after the change. RT wasn’t around for the trach change even though it is a trach they seldom see. I guess they weren’t interested in the procedure or in getting familiar with something that may be the trach in their future. In any case, based on the past, Dr. Cuyler chose to use air instead of saline or sterile water. He felt that would work fine for her. However, during the afternoon and evening the cuff was deflating and by nighttime there was air leaking from Chloe’s nose and mouth. Both the nurse and RT told Dana, twice, that Chloe was safe. She wasn’t. She was secreting into her lungs. The entire night was tag team suctioning. By morning Dr. Cuyler decided to go with saline in the cuff. That halted the problem but the secretions had already caused trouble.

All morning long she was a suction frenzy. Her energy level was down to zero so her progress today was minimal at best. When I took over at 11am, and headed for speech therapy, she was about asleep. Jenny was surprised anyone would say air leaking is normal or safe. While those two were doing their speech thing I read the directions for the Bivona trach. There is a new warning listed in the directions that says air permeates the silicone cuff and that sterile water should only be used. This is something someone in RT should have known when they ordered it and then delivered it to us. Instead they just brought it to us with no instructions that using this would require anything different than what we had. Dr. Cuyler has enough to do without having to stay on top of equipment needs changes, so, once again I place the blame squarely on the shoulders of the RT department.

I let Chloe sleep through her first hour of scheduled PT since she wasn’t able to function. She was a little rested after 2½ hours deep sleep. We went to OT as Rev. Barb showed up for a visit and to deliver a great dinner. We delivered Chloe downstairs and backed off so the three therapists could work directly with her and help her to feel safe without a parent there. All went very well.

Art was next and she did well with Kate. I wasn’t called in to suction once during either session. By 4 PM though she wasn’t too thrilled about going to the Starlite Room activities… but we went anyway… for a little while. She made a heart and we left to get her back in bed. She slept well for another hour.

At 6:30 PM she started the non-stop suctioning with very thick, pasty gunk. That lasted 45 minutes and she finally decided she’d like cough assist for the first time since Feb 3rd. Unfortunately the assist didn’t produce anything but fortunately it was performed just as it should be.

She had a late bath and when she came back she was bringing up quite a bit of phlegm. It cleared well and she was able to go right to sleep after getting her nighttime meds. We are looking forward to a great night.

Be well,
Ron