G-tube leaking :(

[umcRN]

So I am taking care of an approx 6kg baby girl who it fed via gtube and hers leaks something awful! Due to her resp issues she is positoned prone or on her side 90% of the time, she cannot tolerate her back. She is fed bolus over 90mins during the day and cont olvernight, neither seems to make a difference. Surgery has one already removed the button (mickey) for four hours to make the hole smaller and it seemed to work temporarily but we are back to leaking again. Any suggestions? The site looks great but she is soaking through clothes & blankets, and she in on some pretty important po meds too

[NeoPediRN]

It's that damn pulmonary hypertension in the itty bitty ones.

[umcRN, BSN, RN]

It's that damn pulmonary hypertension in the itty bitty ones.

tell me about it, it's been a bad day, had to tell her parents that at this point she likely won't make it to her cath, hell i couldn't turn her over without just about coding her, the vent settings shes on now are one step below the oscillator, and we're supposed to get her to another floor?

ugh! who cares about her g-tube at this point!

[umcRN, BSN, RN]

and not to change the subject slightly (although it's pretty much changed now!)

Are you at Boston Children's? I'm actually from Boston and moved because I was a new grad and wasn't getting much in boston, figured i'd get the experience, travel a bit and head back that way eventually. If you are in boston and the nicu what's it like? i can't find much info on it online...you can PM me back if you want, it might be easier than keeping this thread up as a convo

I've just always wondered what its like and an pretty curious about the differences/similarities between different regional nicus in general

[NeoPediRN]

so sad is her syndrome incompatible with life? Is she on nitric? I work at children's per diem. I'm well-versed with their nicu, and can tell you getting in is very political and the internal wait list is about 1.5 years long. Their nicu does cooling, but ecmo is done in the picu/cardiac picu. 25 beds, everything you can think of. Cardiac kids go to the cardiac unit to stabilize post op usually, and then get transferred back to the nicu. What else are you interested in knowing about it?

[umcRN, BSN, RN]

Hmm not as big/much as I thought! We have 58 private rooms, do body cooling, cvvh, pd and ecmo, but all the cardiac kids go to cicu (which is a bummer for me cuz I'm interested in cardiacs) and basically every other surgery/consult you can think of except transplant

My kiddo is currently on nitric/milrinone/versed/morphine/vec/sildenafil - to hit the major points, and her syndrome is compatible w life

[netglow, ASN, RN]

Advice: you two need to think about taking this convo to the private room... just say'in :)

[NeoPediRN]

There really isn't much further to go from there except ecmo. An oscillator isn't really going to help if its pulmonary hypertn causing the issue, which it sounds like it is

[Esme12, ASN, BSN, RN]

Hmm not as big/much as I thought! We have 58 private rooms, do body cooling, cvvh, pd and ecmo, but all the cardiac kids go to cicu (which is a bummer for me cuz I'm interested in cardiacs) and basically every other surgery/consult you can think of except transplant

My kiddo is currently on nitric/milrinone/versed/morphine/vec/sildenafil - to hit the major points, and her syndrome is compatible w life

There may be only one or two "childrens" hospitals but all our major teaching hospitals have pedi/nicu/cvic......besides Childrens there is The General, Brighams, Tufts, Floating hospital, U Mass, Springfield and Dartmouth Hitchcock In new Hampshire.

[NeoPediRN]

Only mgh and chb do pedi cardiac though. Even dmhc turfs their cardiac surgical kids to those two places.

[NeoPediRN]

Just checking in to see how your peanut is

[umcRN, BSN, RN]

Just checking in to see how your peanut is

She passed away this past Thursday morning, I was lucky to be her nurse that day to help her parents through it. She won't need her g-tube anymore in heaven :heartbeat. Very sad, very quick, she went faster than anyone thought she would, but in the end she blew pneumo and her parents made the brave decision not to put her through a chest tube, which at that point she likely would not have survived through anyways.

Thanks for asking and for all the advice from everyone! And from everyone who posted about hospitals, I am always looking to see what other hospitals are like and how they function. I am hoping to travel for a bit before heading back to Boston so I'm definitely interested in trying a variety of units.

[Esme12, ASN, BSN, RN]

Only mgh and chb do pedi cardiac though. Even dmhc turfs their cardiac surgical kids to those two places.

true...