In pursuit of cream
Every once in a while, my hospital unit will get a patient that has a LOT of drainage from a particular drain tube (chest tube or Jackson-Pratt drain, usually. and that's JP for short).
That happened this week. I had a patient who needed her JP drains emptied at least every 4 hours because they were dumping about 300cc (which is a cubic centimeter, which is the same as a milliliter) each time. So the nurse practitioner ordered heavy whipping cream to stick into the feeding tube.
Yes, really.
Basically, fats (of which heavy whipping cream definitely counts) are picked up by the lymphatic system from the intestines instead of going straight to the liver. When there is a leak in the lymphatic system, the fatty fluid (called chyle) can show up in places it's not supposed to be. Like in the JP drain. The leak can be fixed, but it's really hard to see, so having a really obvious color (like white from the cream) mark the spot can help the surgeon locate the leak. There's the anatomy lesson. But there's more to this story.
The hospital pharmacy doesn't stock cream. It's sort of perishable. So I ran down to Starbucks and asked for 300cc of cream, please, it's for a procedure.
The guy behind me said he wanted that procedure.
The girl behind the counter thought for a bit, as she normally operates in ounces, then asked "Like a Venti?"
Actually, I'm a little unclear on ounces to milliliters myself, but looking at the size, it seemed right.
So I go back to my patient's room with this Venti cup from Starbucks, and I announce to her that I brought her some cream. My nursing assistant was in the room at the time, and she told the patient to make me add coffee to the cream next time.
I poured the cream into a controlled pumping system, then checked on it every 10 minutes or so to make sure it was running. Heavy whipping cream is WAY more thick than what the pump usually works with, and we recently had had one pump turn the cream into a frosting consistency....
Anyway, so I was in there, looking at the pump, looking at the drain, and things were a little indeterminate. The nurse practitioner of cream-ordering fame decided to run all of the cream at my disposal to see if that would murky things up (we were looking for murky white drainage, after all). So we carried on with the waiting game while I reflected on which was worse: having all of that cream (for metabolism purposes) or having all of that cream (for the nice full feeling that fat gives us, but given the amount we were giving her, would probably make her feel stuffed).
When one of the surgeons stopped by to check on her, he asked how much cream she'd gotten so far.
It was my turn to think.
"Probably like 400cc. Not sure. It was a Venti"
I think I'll call it the Substitute Starbucks Measuring System.
That happened this week. I had a patient who needed her JP drains emptied at least every 4 hours because they were dumping about 300cc (which is a cubic centimeter, which is the same as a milliliter) each time. So the nurse practitioner ordered heavy whipping cream to stick into the feeding tube.
Yes, really.
Basically, fats (of which heavy whipping cream definitely counts) are picked up by the lymphatic system from the intestines instead of going straight to the liver. When there is a leak in the lymphatic system, the fatty fluid (called chyle) can show up in places it's not supposed to be. Like in the JP drain. The leak can be fixed, but it's really hard to see, so having a really obvious color (like white from the cream) mark the spot can help the surgeon locate the leak. There's the anatomy lesson. But there's more to this story.
The hospital pharmacy doesn't stock cream. It's sort of perishable. So I ran down to Starbucks and asked for 300cc of cream, please, it's for a procedure.
The guy behind me said he wanted that procedure.
The girl behind the counter thought for a bit, as she normally operates in ounces, then asked "Like a Venti?"
Actually, I'm a little unclear on ounces to milliliters myself, but looking at the size, it seemed right.
I poured the cream into a controlled pumping system, then checked on it every 10 minutes or so to make sure it was running. Heavy whipping cream is WAY more thick than what the pump usually works with, and we recently had had one pump turn the cream into a frosting consistency....
Anyway, so I was in there, looking at the pump, looking at the drain, and things were a little indeterminate. The nurse practitioner of cream-ordering fame decided to run all of the cream at my disposal to see if that would murky things up (we were looking for murky white drainage, after all). So we carried on with the waiting game while I reflected on which was worse: having all of that cream (for metabolism purposes) or having all of that cream (for the nice full feeling that fat gives us, but given the amount we were giving her, would probably make her feel stuffed).
When one of the surgeons stopped by to check on her, he asked how much cream she'd gotten so far.
It was my turn to think.
"Probably like 400cc. Not sure. It was a Venti"
I think I'll call it the Substitute Starbucks Measuring System.
This is one of the craziest and awesomtest things I have ever read.
ReplyDelete