Quick update from my phone

So, Tuesday morning (4:12 am) they ended up starting dialysis on Oakley's new catheter (peritoneal dialysis) that was put in Monday night. They like to give those catheters 2 weeks to heal, but at the bare minimum 24-48 hours of healing time before they use them. The risk for infection was very very high, because the catheter could leak, and bacteria thrive on the dialysis fluid-as it's very sugary. His blood gas showed that Oakley's pH was far too acidic, and didn't think he'd make it 24 hours if they didn't start diuresing though. He had drained over 200 milliliters with the catheter just draining excess peritoneal fluid, but wasn't peeing, so it wasn't enough. Yesterday after morning rounds, Oakley's dialysis had only been draining off about 20-25 milliliters of fluid (outside of what they put it) per hour, and they were concerned that wasn't going to be enough. His pH was still acidic (normal is 7.35-7.45 and his was 7.12) so they wanted to put in a tunnelled catheter up through his right groin-femoral artery.
For those of you who don't know Oakley's vascular background, he has a blood clotting disorder called factor 5 leiden mutation and because of the lines he's had in his body, most of his big access veins and arteries are clotted and unusable. He has a left subclavian clot (so his left shoulder), left iliac vein (the returning blood that compliments his femoral artery) clot, and his right side is currently housing his double lumen Hickman line, whicj goes through his right jugular. This would use his last good spot for lines, and if it clotted off, we'd be screwed. Clotting is a very real danger right now, because his Lovenox (anti-coagulant) had been stopped since Wednesday because of a series of bloody noses, then the ressuscitation and finally, his surgery for putting in his peritoneal catheter.
Trevor and I were pretty hesitant about using his last good artery, and thought they were jumping the gun a little. It hadn't even been 12 hours on his peridialysis and they were unsatisfied and wanting to stick another line in. We were frustrated with a couple other things too (PICU had effectively cut the pulmonology team out of Oakley's consults because they deal primarily with long term issues and not acute injury, the head PICU doc was a jerk and pretty much told me to leave rounds), and ended up setting up a care conference to further discuss the issue.
Between rounds and the care conference, the wound care nurse dropped in and consulted on how to take care of Oakley's junk-see picture from last post- and was looking at his catheter, and urine started dribbling out! He peed 26 grams worth of urine, so they thought his catheter had gone bad. They pulled it, and got another 32, so tey replaced the catheter. He had released 106 grams of pee by the time we had left for the care conference. The doctors seemed less impressed than Trevor and I had been-even though this gave them 5 hours worth of his dialysis output as a freebie. It also meant his kidneys were working a little bit. We left the conference with the compromise to look at Oakley's clotted limbs for line access options and to look into his newfound ability to pee, even just a little. When we got back, a blood gas had been drawn with a pH of 7.21, so he had improved drastically! His CO2 was looking good and his breathing was stable on a lowered pressure.
After fighting for an hour, the fight was nullified for the time being, because he was stable enough to continue his peridialysis.
He was estimated to get about 500 mL's of fluid off in 24 hours of peridialysis, and his urine output was brely significant. At around 5, Oakley's abdomen was starting to turn a little red, and his PD catheter dressing was wet. The changed his dressing, and were watching him. At 8, the nephrologist stopped by, and looked him over. He had the nurse check the leaking fluid for it's dextrose content. It was over 1,000 and Oakley's blood sugar was at 140. The fluid was definately dialysis fluid leaking out. They had a decision to make now; continue diuresing with the leak, inviting infection, they could stop the dialysis and give the catheter time to heal, or they could stop the peridialysis and put in the line and start hemodialysis. They crunched the numbers, and Oakley had given them 585 milliliters of fluid output (thanks urine) in less than 20 hours. They decided to stop the dialysis and let the PD catheter heal for as long as his body can handle. So far, through the night, Oakley's PD catheter has drained over 300 mL's of fluid and his urine out put has been over 400! We haven't rounded or seen a doc yet, but I'm pretty excited! His weight dropped from 9.7 to 8.7-a whole kg! We never thought we'd be excited about weight loss for Oakley, but his starting weight was 7.3, so we're getting back to normalcy much quicker than even the doctors thought could happen!
It's a very real likelihood that he'll have an infection in his peritoneal cavity, his Neutrophils have been acting erratic (they were 5,000 on Saturday, 10,000 Sunday, 21,000 yesterday, and are 4,000 today) and his platelets and hematocrit have dropped, so internal bleeding is likely. We've got such a long road ahead of us, but your prayers are working!