Bad Day

Caydence had to be re-intubated this morning :( She was doing so good on C-Pap all day yesterday and all night. They had moved a 3 year old girl in the room next to her late last night and you could tell that every time the girl would cry Caydence would cry. Around 6am this morning the girl started crying again and Caydence got real worked up and we couldn't get her to settle out. We gave her more sedation but nothing helped and she eventually got so worked up she started D-Sating. All the doctors rushed in and started bagging her and trying everything they could do to get her back and not have to put the tube back in but nothing worked and she started getting worse so they had to put it back in. Dr. Zebrack tried to get it in and was having a hard time, it just didn't want to fit or something was blocking it. Anesthesia  had to be called in to have them get the tube in. He was finally able to get it in after a couple tries but with a much smaller tube. Dr. Zebrack was trying to think of what would be causing the tube not to fit. She thinks that since Caydence has been intubated for so long that there could be some narrowing or scar tissue around where the tube sat or that it could have just been swollen still from pulling it out yesterday, and that when she got so worked up it would just collapse and she was fighting to get enough air in. They did an X-Ray after she was re-intubated and it only showed some collapse on the lower right side. So we know that her bronchus collapsing wasn't the problem because that is on the left side and that looked fine on X-Ray. So we know that she can handle having the tube out and being on C-Pap since she was fine for just about a whole day. Our plan now is to let her get a little rested and get some good nutrition in and try again. We are going to take advantage of the situation and send her to cath lab tomorrow to get a new central line placed. She needs more access for the next time we extubate because she only has one line right now and when we extubated we couldn't feed and we couldn't give TPN because her line was being used for her dex drip. So hopefully tomorrow they will be able to get a good double lumen central line in and then we can also get her broviac line out so we don't have to worry about it getting infected the longer it stays in there. As long as everything goes good and we can get her back down to extubatable settings on the vent by this weekend, then the plan is for Monday to go down to the OR and have ENT there to extubate her and put a small scope in as they pull the tube out to see what's going on in there. If there is some narrowing then they could just balloon it open some, and depending on whatever else they see hopefully they could fix it. It could also be that her trachea is still just a little weak or floppy from the surgery she had on it and that would just need to strengthen up on its own while on C-Pap. Today was such a crazy day. It's just amazing how things could go from great to bad in such a short period of time. All the doctors were so surprised by how well she did having the tube out. She really proved that she can do it. Now we know that when we pull the tube again, she needs to be in a quiet place with nothing that is going to agitate her at least for the first day. It was so nice today tho seeing how many people here really love and care so much for Caydence. While everything was going on with her this morning I would turn around and see our other nurses standing outside our room spending there break time just watching to make sure she was OK. We really are so thankful that we have such great nurses and doctors and know that they treat Caydence as if she was their own child. Everyone in the unit was really pulling for her that the tube stays out, they were so excited that we actually got to the point of it coming out and her doing good. It was really disappointing that she had to be re-intubated and we took it pretty hard at first, but it was what she needed at the time. We aren't discouraged, we know that it will come out again, it just has to be under better circumstances. Like I said too, we are taking advantage of this week and getting things done that will hopefully make it better for when Monday comes around and we pull it again.