IV Pumps and Growing Pains

IV Pumps are Stupid

I have got a guaranteed million dollar idea for you. An idea that seems so simple and obvious that I would be amazed if someone else hasn't thought about this yet.

If you have ever been around someone who is hooked up to multiple IV pumps at the same time, here is how it works:


These Pumps
Are Stupid

• At irregular intervals, something will happen with one of the pumps that usually requires the nurse's attention: there is air in an IV line, an infusion is complete, the pump battery is dying, or the moons aren't aligned correctly. It could be a lot of things.
• The pump will emit an irritating and unremitting beep until someone fixes the problem.
• While the pump is beeping, the sick patient, who may be throwing up or trying to sleep at the time, is supposed to hit the call button to summon the nurse.
• It may be several minutes (always seems longer with the incessant beeping) and someone (who never identifies themselves) says "May I help you?" over the intercom. 
• The person on the other end of the intercom can hear the beeping in the background... so, why not say "This is Suzy, I hear the beep, is there anything else you need?"
• But the current convention is the patient says something inane like "I'm beeping"
• Intercom lady says something like: "OK I'll send someone in to take a look."
• Several more minutes later (again, seems longer than that with the frickin' beeping), a nurse comes in, switches out the IV, or gets rid of the bubbles, or whatever and the beeping stops.
• Many times right after the nurse leaves, another pump will start beeping and the whole process is repeated.

Don't get me wrong, Pam's care at OHSU has been great, the IV Beep System, which I believe is standard operating procedure at all hospitals, is truly stupid.

So, here is my multi-million dollar stunningly simple idea: Develop a telemetry system so that instead of a pump beeping, the nurse gets a message on their little pager, like "Tacrolimus infusion complete, Room 14". THE SAME MESSAGE THAT IS FLASHING IN LED LIGHTS ON THE PUMP... THIS ISN'T HARD.  Don't beep at the patient, BEEP AT THE PERSON THAT CAN DO SOMETHING ABOUT IT! Save the call button for times when the patient needs physical assistance with other stuff, like going to the bathroom or getting a new vomit bucket, things like that.  OK, diatribe on Stupid IV Beep System is over.

Holy cow, annoying! OK, now it is really over.

Discharge Plan

Booth Monkey

Yesterday, I went to a conference for Clinicient to serve as a "Booth Monkey" and I didn't catch Dr. Holtan on her rounds this morning.  But she told Pam it is going to be longer than she thought before Pam can be discharged. They can't consider it until she can eat and take her medication orally, and she hasn't made much progress in that area over the past several days.  Her blood counts continue to look very encouraging.  I think Pam is relieved as much as she is disappointed.

Dr. Holtan has ordered another sputum culture to see if Pam is still testing positive for the flu virus, since it looks like she will be here a while longer.  If the flu culture comes back negative, she can at least get out in the hallway, and we don't have to wear these yellow isolation gowns all of the time in her room.  Should know the results by Tuesday.

Last report we had on Pam's ANC number is 915, two days ago, so it is continuing to improve.  Her GVHD rash is almost completely gone.  The little bit of stubble on the top of her head is also almost gone. All of this is expected, and is a good sign that things are going as expected.  This brings me to a weird symptom that is another good sign:

Growing Pains

Pain Classification in Bone Marrow Transplants

As the stem cells embed and expand in the long bones and pelvis, it becomes painful and it is described as feeling very much like "growing pains" that most of us have experienced as kids.  Deep, achy, poorly localized, unremitting pain, primarily in the knees and hips.  Weird, huh?

For the wonks out there, here is a table of common causes of pain related to stem cell transplants that came from this article.  I have highlighted the probable cause in Pam's case.

So, I am guessing that Pam will not be getting out this week, and that she will be discharged closer to the six week mark since her hospitalization.

More to come...