Managing the pain

It was time to change the nephrostomy dressings on Saturday. The hospital policy is to change them every 2 days, unless the parents refuse. Alan was already on day three which is the most the attending recommends we delay so we changed them today. It took quite a while to remove the old CoverDerm dressing because it has so much adhesive. It just added to the time Alan was upset so we will ask for TegaDerm dressing in the future.

Docs from Pain Service came on Sunday to talk about Alan's pain management. After going over his symptoms, they decided to increase the frequency of PCA button availability and double the dose of the nursing boluses while also increasing frequency of methadone from 3x day to 4x day. It will take some time for the methadone to titrate. They will discuss other options when pain service docs round on Monday.

A doc from Infectious Diseases came because a culture from Alan's port taken on July 25th grew some colonies, despite the fact that cultures from the 22nd were negative (and the PICC lumens are negative). They suspect there may be some infection inside his port. They will ask the Peds attending for an ultrasound on Monday to see if there is a clot in the port (a possible cause of infection) and they will consider changing the antibiotic used.

Because of the pain and his irritability, Alan didn't go to Bingo this weekend, preferring to play with the Bingo cards on his own. We hope the increased methadone will help because we miss our happy boy.


Bingo cards and iPad fun