Friday, February 14, 2014

Showing Some Tubie Love

Not only is this week CHD Awareness Week, it is also Feeding Tube Awareness Week.  Due to Brinkley's CHD he also required a feeding tube.  It is not uncommon for children with CHD's to require feeding tubes due to the fact that they become breathless trying to coordinate the suck, swallow, breathe cycle that is required during feeding.  Generally these children will start with an NG tube or something similar.  This is a nasogastric tube and is inserted through the nose (hence naso) down into the stomach (gastric).  

The NG tube is often times temporary.  After some time, it was determined that Brinkley would benefit from a G-tube since it was becoming obvious that his feeding issues were not going to be resolved quickly.  I was devastated by the news that my 5 week old baby was going to undergo surgery for the tube to be placed.  I was scared to death and thought that it would be so difficult to care for and manage a tube.  Thankfully, nurse Kim who often took care of Brinkley on weekends was the pediatric surgeon's primary nurse during the week.  She was a wealth of knowledge about feeding tubes and walked me through the process and even brought in samples to show me what it would look like and how I would care for it at home.  This eased my mind a little and I realized that agreeing to the surgery may very well be the only way that Brinkley was going to be discharged from the NICU anytime soon.  On October 11, 2012 my tiny little guy underwent his first surgery to have his g-tube placed.  

Surgically placed tubes are usually either G-tubes or GJ-tubes.  A Gastrostromy tube (G-Tube) is placed in the lower left abdomen and goes directly into the stomach.  The Gastro-jujunum tube (GJ tube) is also placed in the lower left abdomen through the stomach but passes through the stomach and empties into the jujunum (small intestine) bypassing the stomach.  Brinkley's initial tube was long and was not removable from the skin.  

 You can't see it in these pictures, but the long tube had a port on the end that you would connect to the tube coming from the pump.  All meds and food/formula were put through the tube.  A few days before our NICU discharge a home health nurse came and trained us on using the type of pump that we would be taking home.  Not being good with math, I was a little intimidated by the "formulas" for figuring out the settings to program into the pump.  Fortunately, our NICU nurses gave me plenty of help.  I also learned really quickly that I could make the pump work a lot better for us by simply reading the instruction manual and learning about features that the home health nurse never told us about.  I also got quite good at figuring out how to "hide" the long part of the tube in his clothes.

I don't remember exactly how long it was, but after a few months (about 3 months) the long tube was removed and a button was put in its place.  The button is more flush to the skin and does not have the tube hanging from it.  It makes dressing much easier and it has to be more comfortable for the patient.    With the button, you put a connector into the button and then connect the pump to that, or push the meds through the connector.  

The button can be irritating to the skin, so many doctors recommend buffering it from the skin.  I have chosen to do this with tube pads.  There are several places that you can order them from and they can be plain or super cute.  Of course, I have opted for the super cute ones!  My thought is that if you need the tube, you might as well accessorize it.  (Especially since I don't have any girls to buy accessories for.)  
These are just a few of the button covers that we have for Brinkley.

When Brinkley's tube was placed I really wished that I had a visual to get a better idea of what to expect.  With this in mind Bryan and I have taken a few photos and made a short (very basic, nothing fancy) video about using the tube.  Before following the steps on the video, you will need to collect your needed items (connector, meds, syringes, feedingbag, etc.)

These are the items that we need on a nightly basis for Brinkley.  You'll see his meds and their respective syringes, a connector, sterile water, and a syringe for the sterile water. I've included a close up of the connector.  I would recommend that you ask for connectors that have med ports.  This means that there is a large opening and a small opening on the end of the connector.

Here is our attempt to walk you through the steps of using the tube.  The best part is the super cute model that we used!

I truly hope that this is helpful for someone and that it helps to ease your nerves about having to use a tube.  It is not at all like I had thought and honestly isn't that big of a deal.  The worst part was figuring out how to hide the long tube in his clothes and being careful not to catch it on anything.  Buttons do have to be changed out periodically.  Brinkley is on a 3 month schedule and they occasionally do malfunction or pull out.  I have had to learn to replace it on my own.  This was a TERRIFYING thought to me, but Nurse Kim made sure that I was more than prepared and now I do it like a champ in less than 2 or 3 minutes.  

I hope that you don't ever need to know how to do this, but if you do or if someone you know does, please pass this on.  Feel free to contact me if I can help with more info or more photos.  My experience isn't worth much if I don't share it to help someone else!

Thursday, February 13, 2014

Happy "New" Heart Day Brinkley!

If you follow me on Facebook or Instagram you may have noticed that this week is Congenital Heart Defect Awareness week.  I have been posting facts about CHD's each day for the last two weeks.  CHD is something that affects our family very closely.  As a matter of fact this week happens to be the anniversary of Brinkley's second open heart surgery.  

Last year at almost this exact time, this is where I found myself and my 5 month old son.  At 1:15 on 2/13/13 we had an appointment with pulmonology for Brinkley to receive his RSV vaccine.  The days leading up to this appointment his 02 sats had been fluctuating greatly.  The same happened in the pulmonology office as well as a heart rate in the 40's.  We were scheduled to leave pulmonology and go downstairs for a routine echo in our cardiology office.  It became quite clear that the Pulmonologist was very concerned with Brinkley's vitals and he called the cardiology office and insisted that we needed to be seen by the doctor rather than just the tech doing the echo.  Our doctor was not in the office and the only one on hand had never dealt with us before.  

We proceeded downstairs to be quickly met by Dr Lucas and even more quickly swept away to the echo room.  This echo was quite short and was followed by a conversation with the doctor that we would be heading straight to the PICU and should expect to be flown to MUSC before the end of the day.  Brinkley had gone into complete heart block and needed immediate surgery.  I'm not sure that I realized how serious the situation was at the time.  Complete heart block means that the top and bottom chambers of the heart are not working together and it is not uncommon for this to be fatal.  

We spent about 12 hours in the PICU at GHS while waiting for a flight to MUSC.  About 4am we were airlifted to MUSC and within a few hours Brinkley was taken back for his second OHS.  This time his initial TOF repair was revised and a pacemaker was placed.  If you are thinking about the dates, Brinkley's "new" heart was placed on Valentine's Day.

Let me just say what a difference a year makes!  Today Brinkley is missing therapy due to a snowstorm, but he would normally be amazing us all on Thursday morning with his attempts to walk and crawl and his awesome progress in OT.  Right now he is crawling around the playroom eating every toy he can get his hands on.  It's hard to believe that the fragile little guy in the picture above is the feisty, wild man that we live with today.  He is so full of life and we have an amazing team of doctors and therapists to thank for helping us get to this point.  

I know at least three other local moms that have had to leave their babies in the hands of the MUSC team over the last couple of weeks.  I write this to hopefully encourage you and to let you know that I've been there too.  Those moments and days can be so overwhelming and down right terrifying.  We prayed (and continue to) that God would give us just the right team to help Brinkley and He was faithful.  It has not been an easy road and there have been many set backs, but God is good and we see His hand in Brinkley's life everyday.  

Many people ask about Brinkley's scars and I wondered about scars as well when we started this journey.  I just noticed last night how well he has healed and I wanted to share it as encouragement as well.  

This is the scar following the second surgery.
Scar as of 2/13/14