3 procedures in 1 day!

While the rounds were four hours long this morning, I saw three medical procedures take place! 

1. A year old little boy being extubated (taken off the artificial breathing system)

2. A Dophoff feeding tube being placed in a teenager (for tube feedings)

3. ECMO (artificial blood oxygenation system)

The first, the extubation, was very anticlimactic but incredibly interesting nonetheless. It was a little 1 year-old boy who had been on a vent for about a month or so. He was admitted for seizure activity monitoring and then had some complications with that. Basically there was 2 nurses, 1 attending doctor, and myself in the room. They got a bunch of drugs ready just in case the patient had problems with the extubation or the patient starting to have respiratory arrest or even cardiac arrest. They starting taking out tubes one by one and then quickly slipped out the respiratory tube. The patient was squirming with agitation and crying and while this is sad and hard to watch, it's a really good sign - only because it's good to know the patient is still conscious and has full feeling and no paralysis. This procedure wasn't as intense as I was expecting, but then again, the patient was extubated without any problems, which is a good thing!

Secondly, I saw a tube feeding being placed, which was extremely interesting. First is deciding where the tube is going to go once it's in the digestive tract. The end of the tube can either hang out in the stomach and the formula will be dripped into there, or it can be placed past the stomach and into the jejunum (the area of the intestines right past the stomach). These are used for patients who are at aspiration risks and especially those who are on ventilators. When a patient is on a ventilation, especially CPAP which has really high pressure on the stomach, it's important to put the tube as an NJ tube (nasojejunum - in through the nose and into the jejunum) so the patient doesn't have the formula come up and either vomit or aspirate into the lungs (which would cause pneumonia or infection). 

First, the tube was covered in a little bit of lubricant and was fed through one of the nostrils. The patient was then told to drink from a juicebox to help guide the tube down. What stinks about it is that I could tell the patient was incredibly uncomfortable, I can't imagine it'd be a great experience. I can't stand the feeling of having a hard booger in my nose but let alone a massive tube being fed down into my stomach. To make sure the tube is in the right place, they go to radiology to have an x-ray done. It's important to do this to make sure that the tube didn't end up in the lungs by accident, isn't coiled up in the stomach, or made it to the right place. 

Lastly (phew!) I saw an ECMO machine in use. ECMO stands for "extracorporeal membrane oxygenation," which is just a long word for a machine that takes blood out of your body, runs it through a machine and oxygenates it and/or helps your heart pump the blood by running it through a membrane, and then feeds it back in. What was craziest about this machine is that the tubes that take the blood out and put it back in is like half an inch wide and takes blood from the patient's leg and puts it back in the neck. I went back later to get a "tour" from the tech working the machine. Yes, there is a technician that sits there 8 hours a day and constantly monitors the machine.

Back up, this machine is MASSIVE. It stands what seems like 8 feet tall and is about 3 feet wide. They monitor hematocrit and glucose every hour, as well as clotting time. The clotting time test was really neat as well. They put about 4mL of blood into a vile that has broken glass inside and the amount of time that the blood takes to begin clotting the broken glass is the clotting time. This is important to know because they put heparin (anti-blood clotting medication) into the ECMO machine to keep the blood from clotting within the machine. The University of Michigan hospital is one of the few hospitals in the Midwest to have ECMO machines. It's kind of a "last resort" for respiratory and/or cardiac failure. Sadly, the patient who was on it today was a previously healthy little girl who was exposed to H1N1 and it turned into a super-infection that started to cause multi-system organ failure...

Anywho, today was a long day. Tomorrow will be another day full of procedures as I will watch a TPN solution be made first thing in the morning. I've always been really interested in how it's done! I'll report on that tomorrow.

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