Saturday, January 26, 2013

Something I learned about procedures.

In addition to this being a place for me to update family and friends about Ryan's progress, I'm also hoping it will be a resource to other parents going through the preemie (ex-preemie) journey.

*Side note* Some of my friends in a preemie support group I'm in mentioned how odd it is that the doctors always refer to our kids as ex- or former preemies.  Like when they rounded on him this week in the CVICU, they said, "This is Ryan Aprea, ex-25 weeker..." when they were giving his report.  Which I guess makes sense because he's not 25 weeks old anymore, but it does sound odd. 

*Side note #2* As I'm typing this, both kids are sleeping.  Dave goes in to check on Ryan who is sleeping soundly, and comes back and says, "I'm going to test his hearing while he's so sound asleep."  So he grabs Sophie the glorified chew toy and walks back there.  Then I hear "SQUEAK SQUEAK!!!" followed by silence, then the sound of DANI waking up in the other room, followed by Dave walking back out saying, "Yup, he's deaf."  Just a typical morning in the Aprea house!

Back to my original purpose in writing this, I learned something pretty important after our stay in the CVICU this week, and I think it's important to share.  You know how before a procedure, the nurse will call you with your pre-op instructions.  They give you all the directions for when to stop eating, stop drinking clear liquids, etc.  For babies, they try to do the operations as close to the beginning of the day as possible so they don't have to go as long without their food since they can't really understand why they are fasting.  Well, Ryan had to do his procedure a little later in the day since it was a reschedule and we already had our EDAC evaluation in the morning.  Plus they wanted him to be the last one scheduled (he was supposed to go in at noon) so that they could have the room a little longer to get the ABR done. 

Well, each time we were called with pre-op instructions, it seemed that the information was always slightly different.  First we were told no milk after midnight.  Then it was plain breastmilk was fine up until 8:30am.  The last nurse who called the day before said no breastmilk after 5:30am because they changed our procedure time to 11:30am and he shouldn't eat past 6 hours prior.  So I went with that one, since I questioned it and she went and checked with some other nurses while I was on hold.  She also told me that I could give clear liquids like water, pedialyte, or juice up to 3 hours prior.  I told her he's never had juice or pediatlyte, but I could do water, and she went to check for me again to see what would be best.  We decided that since he wasn't used to large amounts of water, we would just wait and see if he got fussy/hungry, and then I could do a few ounces of water, otherwise, he would probably be fine.  So, that's what I did, and he never got fussy, so he had his plain breastmilk at 5:30am and that was it.

After the abnormal EKG and spending the night in the CVICU for monitoring, his cardiologist came to speak to me right before we went home.  I was asking her about the meds they used and what might have caused this to happen so I could be sure to ask them not to use these sedatives next time he has a procedure.  One of the things she mentioned that I found so interesting was that he might have been dehydrated which could've caused the pressures in his heart to drop and cause the abnormality on the EKG.  She asked how much he had been fed, and I told her I gave him his last feed of plain breastmilk at 5:30am and then he had nothing after that.  I had always been under the impression that the reason for withholding food and fluids before a procedure was so that they wouldn't throw up and aspirate while they were sedated.  She told me that the lack of fluids in his system could've been part of the problem.  That the fluids provide fuel for the heart to keep the pressures going.  I never ever would've thought of that.  So next time, we will definitely give water or pedialyte up until the last possible minute to help prevent this from happening again, and of course we'll make the anesthesiologist aware of the meds that were used this time so we can try to avoid them.  Just thought I would share that in case anyone else can avoid this happening by giving the extra fluids. 

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