Off the Vent!

Ruby with my ring around her hand.

Millie off the ventilator and opening her eyes!

They took Millie off the ventilator today. When they did a chest x-ray this morning it was obvious that the right side of her lungs was not expanding like it should be (from when they got over expanded the other day). I don't understand all the logistics (yes I went to nursing school but not respiratory therapist school), but the thought is that the ventilator is making it worse. The respiratory therapist thought that taking her off the ventilator would help, especially since she was on so low of a vent setting. He switched her to a nasal cannula just like Ruby's, and she did great. Millie and Ruby are both now on nasal cannulas with room air oxygen (21%). I happened to be there when they did the extubation, but I couldn't watch. It's not a big deal procedure, but I've found that I can't watch anytime they do things like suction their mouths or reinsert the feeding tubes. Just writing this I have a big frown on my face. Any other patient I would be fascinated, but my own children - no thank you! When I left Millie's oxygen sats were dipping down into the 80's (normal sat is 90 to 100) and the alarms were beeping on her monitors, so I was very nervous. Her nurse said this was not a big deal unless it got worse or stayed like that. It's normal to dip up and down with preemies, and especially if Millie has a big PDA (the open ductus arteriosus I mentioned the other day which prevents her blood from oxygenating well). I called later in the day and she was still doing well. YEA!

Ruby is now getting 3 ml's of breast milk in her feeding tube every 3 hours and seems to be tolerating it fine. Millie is now getting 1 ml of milk every 3 hours. They will keep increasing as tolerated until it is considered a real feed and not just stimulating their stomachs. Ruby now weighs 1 lb 10 oz and Millie weighs 1 lb 15 oz. This is expected weight loss and their weights the last two nights stayed the same, so maybe now they will start gaining weight. 

Both of the girls have umbilical catheters (like an IV through the belly button) where they are getting medication, TPN (total parenteral nutrition), and get their blood drawn. These catheters are not permanent for several reasons (they can come out easily when the babies are moved, so we can't hold them, they can get infected etc). The goal is for the girls to get PICC lines placed (peripherally inserted central catheters) which is a semi-permanent IV that gets inserted in the arm and threaded over the shoulder until it reaches a larger vessel near the heart. They attempted to place Millie's last night and Ruby's this afternoon. Neither attempt was successful. The girls veins are so small and fragile. They told me that they could see the veins, but when they tried to insert that the vein moved or rolled, and they couldn't get it. It breaks my heart to think about it, because I know it hurt to have it attempted, and now they will have to try again in a few days. I was told that both girls were not bothered for long and they did give Ruby some sucrose during the procedure (not sure about Millie). It also means more days that we can't hold them. 

That's it for now. I feel like I am being very wordy and maybe not everyone wants all the details. It helps me to process it and very therapeutic for me to write it. At least you can just look at the pictures if you don't want to read it all!