Linda is still on the ventilator. A couple trials of breathing on her own failed to convince the doctors that it is time to take out her endotracheal tube. In fact, now they are recommending a tracheotomy to reduce the risk of vocal cord erosion from the ET tube. Yikes!
Yesterday morning I noticed that her right arm was beginning to swell around the elbow joint, below the point where her PICC line was inserted. The nurse asked for a Doppler exam, and the ultrasound folks determined that clots were forming around the PICC line catheter. So, to avoid the risk of a large clot forming, dislodging and becoming a pulmonary embolus which could do further serious injury to her lungs, they moved her down to the interventional radiology operating room, where a right jugular central venous catheter was inserted and the PICC line removed. In order to accomplish this, all her IV connections had to be unfastened, and she had to be transferred from her hospital bed to the IR operating table - another move with her chest tube in place. Scary to say the least. But she came through the procedure OK and now she is back in her TICU room with the IV lines reconnected to her new right jugular double lumen catheter.
So, now with Linda still unable to speak because she is still intubated on the ventilator, I have to try to discuss with her four treatment plan alternatives her doctors are presenting: continuing with TPN feeding and ET ventilation [this is what she has now]; tracheotomy with TPN feeding; tracheotomy with NG tube feeding [she tried to pull out the tube the last time doctors had her on an NG tube]; or tracheotomy with a PEG feeding tube directly through her abdominal wall into her stomach. I've been up all night perusing the medical study articles on whether there is any difference in outcome with early tracheotomy as opposed to weaning off the ventilator and an ET tube. The literature is mixed. I'm having a difficult time getting my brain around the advantages and disadvantages of all four alternatives, much less figuring out how I'm going to talk this over with Linda in her present condition.
Wish us luck!
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