Today, I'll try to describe the medical procedures and supplies that I will be responsible for until early May. As you know, I was released from the hospital on Friday, April 11, with an unhealed esophageal perforation. Well, not completely healed, but sufficiently so that I was deemed fit for home care.
The overarching concern for someone with my kind of injury is avoiding infection. This is achieved by:
- Avoiding food and liquid intake by mouth ("NPO")
- Administering IV antibiotics on a regular basis
Because of this, I have three rules to observe while my wound is considered unclosed:
- I am not to eat or drink anything, but I may munch on ice or rinse my mouth with water, provided the fluids are spat out afterwards.
- I must administer TPN nutrition to myself every 24 hours, and keep the nutrition bag and pump on my person at all times.
- I must administer IV antibiotics to myself for 30 minutes every six hours, without exception.
#2 and #3 aren't hardships, but they are inconvenient. We'll start with the TPN.
TPN, or "Total Parenteral Nutrition", refers to the delivery of nutrients via intravenous catheter. It's used when someone has an injury or condition that prohibits normal food intake. In my case, my doctor has developed a mix of proteins, lipids, various vitamins and other healthy things into a bag of white slop that I consume daily. You can see my typical TPN bag below:
If you look closely, you can see things like the various ingredients of the TPN mix, the dosage and infusion rate, and other details. Each pack of TPN mix is dispensed over 24 hours, and must be kept refrigerated until 2 - 4 hours before use. It's important that the TPN bag be taken out of the refrigerator several hours before use, or I could put myself into shock by infusing icy liquid into my veins.
Before use, each TPN bag has to be injected with additional vitamins that my doctors feels I need. Once the TPN bag is ready, I connect it to a small, battery-powered pump that manages the rate of TPN infusion:
This pump attaches to special sensors on the line from the TPN bag, and alerts me if there is anything blocking the line, or when my dosage is complete. The pump is very easy to use, and comes preprogrammed from the pharmacy, so I don't have to worry about altering infusion rates or other settings.
Right now, I change the TPN bag around 6 PM, but that may change to better accommodate my schedule. I may also be able to have the infusion rate doubled, so that I will only be connected to the TPN pump for 12 hours a day instead of 24.
Preparing the TPN for use takes about 10 minutes. Without going into all of the steps, I have to flush my IV lines, add the vitamins to the TPN, attach special tubing to the TPN line and connect the tubing to the pump, change the pump batteries, sterilize everything, and connect the TPN line to my PICC line and start the pump. Afterwards, everything runs without interaction unless there's a problem.
Conveniently, the TPN bag and the battery-powered pump fit inside a special backpack, which gives me some mobility:
Above: My stylish blue backpack. Note the TPN line running out of the side.
Although I managed to lose about 15 pounds while in the hospital, I think the doctors decided to help me regain my muscle strength by saddling me with 12 - 15 pounds of TPN fluid and equipment to lug around each day. I feel like some tragic Greek character who is being punished by the gods by being forced to carry around a heavy weight all the time.
I also have antibiotics to apply every six hours. This has been the really life-altering thing, since the rotation that I've settled on requires me to get up at 6 AM every day. For those of you who know me, this is unheard of. Prior to the accident, I could barely get out of bed at 8:30 AM. The antibiotics infusion only takes about 30 - 45 minutes, but unless it's the weekend, I don't see much point in going back to bed, especially since I'll be working again soon.
The antibiotics come in an unrefrigerated pack that looks like this:
The antibiotics are a little simpler to set up than the TPN. The picture is dim in places, but you can see the main body of the pack, a glass vial, and a plastic reservoir with a spike at the top that runs into the main pack. I start by mixing the powder in the glass vial with the fluid in the main pack by breaking the tip at the top of the vial, and the squeezing the pack to mix the fluid and powder. This activates the antibiotics, since the active mix denatures if left unused. Once that's done, I connect the plastic reservoir by inserting a hollow 'spike' into the pack, and then connecting the IV line which runs from the base of the plastic reservoir to my IV. Of course, in between there is much sterilization, and the line has to be cleared of air first. The line is shown below:
On the right is my arm, covered in a sheath to help me manage the excess of PICC cables. Moving away from the arm, we see a white block; that's a clamp that can be used to prevent fluids from moving along the line. Next is the actual PICC line valve, which is connected to the valve for the IV line. Past the line 'joint' is a yellowish object. That is actually a dial that lets me manually control the flow rate along the line. I can shut the line or open it completely; or set it to one of several preset rates. Being able to shut or open the line is useful when pushing air out of the line or draining excess fluid once infusion is complete; otherwise, it is set to a specific rate while I am hooked up to it. Once set up, I don't have to do anything but wait for a little while.
There aren't any real side-effects to either of these treatments that I've noticed. Everything else seems to work pretty normally.
I'll post more later, once I'm done with my doctor's appointment.
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