No to PICC line, CT scan; Yes to scope, IV, antibiotics

Our plans have changed since the post last night.  Here’s the new direction:

We had the PICC team come in this morning to evaluate her.  Unfortunately, the only vein they could find that had not been damaged from the repeated blood draws is very small.  It was small enough that they weren’t confident that the PICC line insertion would be successful.  That realization, combined with their opinion that the risk of a PICC line outweighs the convenience of getting easy access for blood draws, rules out the PICC line.  They said they’d still try if we wanted them to, but we decided against it and came up with a backup plan.

The PICC team did find that her saphenous veins in her ankles are easily accessible.  The general phlebotomy team that comes around to draw blood doesn’t touch those veins so they’re still OK.  So, there were three reasons they needed an IV (and that a PICC line would also have worked):  (1) the contrast for the CT scan, (2) antibiotics, and (3) for general anesthetic during her scope.

The doctors had only wanted to do a CT scan because of our apprehension in doing a flexible sigmoidoscopy (a kind of mini colonoscopy) that would require general anesthetic.  After her incident last year, one of the potential causes of her crash that was tossed around was a bad reaction to the anesthetic (although it was never proved or disproved at the time).  Yesterday and this morning we spoke with two different members of the anesthesiology/sedation team and, based on the data from last time, their opinions, and our impression, we feel much better about allowing her to undergo a procedure that requires general anesthetic.  Now that we’re OK with the scope procedure, they don’t really need the CT scan therefore don’t need to put in any contrast.

The antibiotics are to take care of the as-yet-unproved infection.  Right before they gave her the first set of shots yesterday, they got both a urine and blood sample to try one more time to see if they could get any bacterial growth out of them that would show an infection.  We’re not really confident that they’ll see anything grow just because they haven’t seen anything yet in any of her other urine, blood, or stool cultures.  That said, we should know in about two days if there’s any growth.  If not, they’ll stop the antibiotics.  If so, great — we’ve found our “smoking gun” and hopefully the antibiotics would fix it.  That said, since they can give the antibiotics through shots and it may only be two more sets, they don’t really need an IV for that either.

The last reason of needing one when she has her mini-colonoscopy is the one we can’t really get around.  We’re OK with her getting an IV for that, however we don’t want them to do it until we know when the procedure is scheduled.  Her legs are still going back and forth between being somewhat swollen and really swollen because of her low albumin levels, so we’re nervous that if they put in the IV today and we don’t get on the schedule for several days, that’s more time that the IV could go bad before it’s really needed.

So, with all that being taken into account, we’ll get the IV line in her ankle closer to when she’ll need the scope.  They’ll also be able to give her something to keep her calm when they do it since she’s gotten so paranoid about anyone coming near her now (and I can’t blame her).

They’ve also cleared her to eat whatever she wants until they do the scope.  She hasn’t eaten anything today since she’s been very tired and is actually still in bed.  She’s been dozing on and off all day.

Also, I have to say, we had one of the best nurses here yesterday that helped keep us sane while all the specialists and doctors were in the process of coming up with their plans (and giving us a little contradictory information).  Thank you Janet for helping yesterday.