This morning in the fifteen minutes I’d been gone from my primary baby’s room between the attending assessing them and the surgical team was in for rounds, my baby pulled out his NG tube. No big deal, right? Not usually, but they had to have the tube placed in fluoroscopy... yesterday. Why? They had a TEF ligation and primary EA (esophageal atresia) repair... i.e. surgery to fix a tracheoesophageal fistula (TEF... a hole the body created between the trachea and esophagus) and attach their their esophagus to their stomach (something that should’ve happened while they were cooking, but for some reason hadn’t), and the surgeons are very protective of their anastomosis. So we can’t just blindly put tubes down the esophagus like we normally do since there is a potential that we could harm the surgical site and the tube would not go to it’s intended destination... the stomach.
I had watched that tube like a hawk all night. I was in there at least hourly watching the PIV we’d had to place after their PICC line had clotted off (not to worry, we TPA’d it and it was saved.) The PICC had clotted off because when the day nurse changed the lines down to the hub, she hadn’t attached the port on straight when connecting the lines. I discovered this at shift change when I noticed that the patient’s blankets were wet. If you don’t have anything running through a 1.9F PICC (the line is like the width of a hair) for too long it will become occluded. The baby’s line had gone 3+ hrs. Yikes. Another thing to worry about with this is my baby is getting the entirety of their nutrition from their IV. They’d had all of one trophic NG feed (a small amount, about 10-20cc/kg to prime the stomach if they’d never had food or it had been a while... nowhere near close to a full feed). Because of all this they could’ve dropped their blood sugar since babies don’t regulate it very well thus why they eat so often, thankfully they hadn’t. We were lucky. Unfortunately because it was never connected properly and therefore the sterility was in question, we had to throw out their PN and lipids (their IV food). We gave them some sugar water with electrolytes to maintain them until they get their new PN/lipid delivery later today.
The kind of funny part about the baby pulling their tube is that neither of the surgeons noticed and neither did the NICU fellow. I was the one that had walked over to reswaddle the infant while they talked about going up on their feeds today. I was like, “That’ll be great. They’ll love that... just as soon as they get back from fluoro to get their tube replaced that they seem to have pulled out in the last 15mins.” *facepalm*
Oh well, that was longer than I intended and I need to get to the gym. Hope you learned something... whether you wanted to or not. :P