Lumen issue

Malcolm's platelets were 31 today, hemoglobin was 79 and ANC was 18. So he will likely need another platelet transfusion within a couple of days and some red cells in near future. He is starting to look quite pale but his energy level is good.

There has been some discussion about Malcolm's central line. One of the lumens is showing some wear and tear. The clamp is weak so a small amount of blood is leaking into the cap. This is not considered to be a major problem. However, the same lumen has developed a very thin spot in the line near the cap (ie the end). This is potentially a major problem. The central venous access nurse, an expert in central lines like Malcolm's, came up to see it and she is of the opinion that it is at high risk of breaking if they need to use it again. They will need to use it if Malcolm develops a fever while his counts are low to administer antibiotics. So her preference would be to pre-emptively repair it. This would involve a surgeon coming up to remove the lumen and splice in a new one. Malcolm could be awake for the procedure and it would not involve any pain or discomfort to him (but he would have to sit still while they were doing it!).

However, the oncology doctor has decided not to have it repaired because Malcolm's counts are low and repairing the line, while a sterile procedure, does carry a small risk of infection. So I guess we are just crossing our fingers that, if they end up using it again, it does not actually break, which of course would also result in a risk of infection, and then the repair job would be done on the fly rather than in planned, controlled circumstances. Malcolm's doctor has not actually spoken to us regarding his decision so perhaps he has some sort of plan in place...

Malcolm continues to do well. Donovan had a huge amount of fun at a Christmas party here at the hospital yesterday evening - a tree light ceremony, a band who sang carols, lots of cookies and a visit with Santa were made all the more fun by the fact that two of his little daycare buddies were also here for the party (their parents work at the hospital). Photo with Santa to follow soon.

Mary Ellen