Everything seemed calm at 12:30. Namine was resting peacefully; her wound vac chugging away silently, slowly doing its job; no alarms alarmed. I felt safe that I, too, could rest. I was wrong.
I was awoken by the wound vac alarming at just a little past 1:00. “Blockage detected.” The nurse was nowhere to be found, and I, not knowing where the nurse call button was, dashed into the hallway. “I need Namine’s nurse!” I yelled into the hallway. “Someone find me Namine’s nurse!”
It seems strange to me how movies often depict hospitals, especially nurses’ reactions to alarms. In the movies, the very moment an alarm goes off, a gaggle of nurses come dashing down the hallway to the patient’s rescue. Not so in real life; I think that perhaps they become so used to the sound of alarms, perhaps it doesn’t even register anymore. (Apologies to you nurses who have not yet become so jaded.)
Alarm or not, the distress in my voice certainly brought Namine’s nurse in. She determined that there must be a clot somewhere in the tubing; the most likely places were where the tubing connected to the machine and where the tubing was secured to the dressing over Namine’s chest. The result of the block was immediately apparent, on lifting Namine’s gown to see the dressing: blood was seeping in places out of the sides, more quickly in some areas than others,
Replacing the canister, and along with it the tubing, was relatively easy. It would also involve no interruption of Namine’s sleep. (She was, thus far, still sleeping peacefully.) I say “relatively,” of course, because ordering and receiving a replacement set of tubing and canister took more than a half hour. I spent the time alternating between worry over Namine and rage at the godforsaken slowness of the hospital.
Finally the replacements came, and after Namine’s nurse finished – along with the assistance of another – the vac machine still reported a block. The two nurses combed over every inch of the tubing, checking and double-checking for clots, finding none. The remaining decision was clear: Namine’s wound vac dressing would have to be changed.
The nurses paged the cardiac ICU doctor and the CV surgery physician’s assistant. When the PA arrived, he explained to me that due to the blood thinners Namine is on, it was no surprise that the wound vac ended up clotting the way it did.
Wait, what? Yes, that’s right: being on blood thinners, she was more likely to clot. The reason, though, is not directly due to clotting; instead, it was because the blood was able to flow more freely than if it were not on thinners. The increased amount of blood, then, was more than the wound vac’s rate was able to handle, resulting in the clogged tubing.
So the PA concluded that simply replacing the wound vac dressing would not solve the problem. There remained two potential solutions. The first: take her down to surgery, cauterize the bleeding points, and reinstall the wound vac dressing. (I was none too thrilled with that one. Next option, please.) The second: remove the wound vac and replace it with some packing (basically gauze) and a drainage tube with some negative pressure.
The PA consulted with Namine’s cardiac surgeon, and they arrived at the conclusion that they would go for option number two. It was less invasive and it would allow Namine to remain in her room here in the cardiac ICU. The whole thing took about an hour, perhaps a bit more; Namine is now sleeping peacefully once again, packing and drainage tube in place.
Namine had a chest x-ray scheduled for sometime between 4:00 and 5:00 this morning. But since it’s 4:35 now, they’ve rescheduled it for 8:00 for the sake of letting her get some rest. They’ll also do some more blood draws, but that’s no big deal as long as Namine still has the PICC line. The CV surgery team will convene later this morning to discuss what to do about Namine, as well. If the bleeding has slowed down enough, they may remove the packing in favor of putting the wound vac in place once more; they may even close her chest up and call it good. (Personally I think that’s raising my hopes a little too high this early, but I suppose we’ll see.)