At the end of July, I was hospitalized once again for a central line bloodstream infection. I had a PICC line at the time so I could stay hydrated. My regimen was to infuse 1.5 liters of IV Lactated Ringers 3-4 times a week. Out of the blue, on July 26 and 27th, I started having severe muscles spasms throughout my body, rigors that had my body shaking uncontrollably, and intense chills that sweatshirt, heating blanket, and heating pad couldn't even touch.
The first time this happened on Friday night was scary, as every time I've had these symptoms, I've ended up hospitalized for central line blood infections. I tried to avoid and find excuses of what else may have been to blame for how I was feeling, as an infection and another hospitalization was the last thing that I wanted. When it happened again on Saturday night, I knew the possibility of an infection was becoming evident, so I reached out to my GI doctor. Sunday, I finally gave in and visited the dreaded emergency department.
As I explained my symptoms, I felt absolutely horrible. I made them aware that previous central line infections have been the source of these awful symptoms in the past. In addition, I went ahead and let them know that both my GI and I felt as if blood cultures needed to be drawn. They followed the suggestion and also took additional labs, which led to chest x-rays and a CTa.
Because of my previous infections, they felt it best to keep me overnight in the observation unit. The admitting doctor expressed how confident she was that I did NOT have an infection this time. She thought it was probably just a little virus, as I was not running a temperature and not in distress while there. I responded to her by telling her that I hope she was right, but from my experience, it was likely going to be an infection.
The following morning, I learned that my cultures were indeed positive for klebsiella, both from the line itself and from the peripheral (arm) draws. A hospitalization and PICC removal was in my future, along with a difficult decision.
Due to my susceptibility of infections, my hospitalist, the infectious disease team, and my personal gastroenterologist all felt that not replacing a central line would be in my best interests. Having a new line was more life threatening at the current time that battling dehydration daily. This time, I had no rebuttal as my body and mind is tired of fighting infections. My family and I agreed that I would attempt to be creative and find a new way of receiving hydration.
Unfortunately, my body is not as cooperative as it needs to be. We started implementing more fluids in the hospital by flushing 200 mL of saline 3 times a day through my g-tube. EPIC FAIL as nausea, heaving, and abdominal pain was too much. Then we tried it through the J tube, which was better, but still too problematic. The first flush of the day was manageable, the other 2 were not. After those attempts, we decided to try unflavored pedialyte on a slow drip through my J tube overnight. We set the pump for 20 mL/hr of pedialyte for 10 hours (200 mL total) and during the day continued to run my Peptamen AF formula at a rate of 35 mL/hour. This has been tolerable for the most part, though I have had to adapt the times a little and still have to figure out how to convince my body to accept more formula and fluids as I'm currently only receiving a max of 500 - 600 calories a day and much less than 1.5 Liters of fluids, which is the ideal and recommended amount.
What does this mean? Basically, I am staying dehydrated around the clock, but thankfully not enough to require a hospital visit. I feel lightheaded, weak, nauseated, crampy, everyday and am having issues with headaches/migraines, dizzy spells, breathlessness at times, and tachycardia episodes. Regardless of how I feel, I'm having to make myself feel worse by pushing the level I can tolerate so I don't become too dehydrated or malnourished. My medical team and I have to keep a watchful eye on how my body is tolerating the decrease and lack of fluid volume. On a positive note, my body can at least remain free from another central line infection for the time being.