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Discussion

chylothorax

Hi, we have a 23 month old kiddo in our unit, who developed Chylothorax post TOF and ASD +VSD repair, he was transferred back to our hospital,his home town, he had to go out of town for the procedure, his abnormalities were to complex for our surgeon,the procedure was done in September and they have been struggling to get him of the vent since, eventually trached him and sent him home to us to try and get him off, just wondering how common this is, we have never seen it before so it is new to us, he had ICD insitu but they removed them before they transferred him, and rather than re inserting a drain we are treating it with MONOGEN and ocreotide infusions, however his peripheral line infiltrated last night and we were unable to establish access so obviously he isn't getting that, I hope the Paed was able to establish proper access today, will see tonight, but if not will the monogen be enough, apparently they don't want to reinsert the drain as it will just perpetuate the condition??

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    It's pretty common on units where lots of cardiac surgical patients are admitted. Some children don't respond to conservative therapy and need thoracic duct ligation to prevent ongoing recurrent chylothoraces. Monagen may need to be the only feed for weeks or months. We don't find octreotide to be all that effective and rarely use it. It's not uncommon for a patient to have bilateral Jackson-Pratt drains, or to have pigtail drains placed. The rationale for that is to allow for improved ventilation; the child may need intubation for a prolonged period before transitioning to non-invasive positive-pressure mask ventilation like BiPAP.

    This child needs a PICC line...

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    We see this a lot too, lots of open heart population in our PICU. One thing our intensivists sometimes do is fat-deprive the kids. I've noticed it works about 50% of the time.

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    In recent months we've moved away from Monagen for feeds to Lipistart. I'm not really sure why, since our clinical dietician/PhD tells me there's no real difference in the type or amount of fat in either. A while back one of our nurses went on a medical mission to Honduras and while she was there one of their patients developed chylothorax. Of course Monagen wasn't available so she contacted the unit to find out what they could use that would be readily available. The answer to that is skim milk to meet 100% TFI with MCT oil added to make up 40% of the desired caloric intake. And if MCT oil isn't available coconut oil can be substituted.

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