June 25, 2015 "Shunt Infection"

We got settled into room 6C15 about 4:00 am! Poor little Rayden had been poked and prodded so much. We were all so tired. Michael and I layed down on the pull out coach bed in the room. His nurse came in at 4:30 and 5:30 to administer antibiotics in his IV. The pediatric neurosurgeon came in at 6:00 am to tell us that the culture had started growing which means his CSF is infected (meningitis). They had already scheduled the surgery at 11:30 am. I couldn't believe he had a shunt infection! How in the world did this happen? What does this mean? My poor baby keeps having trouble. This will be his 6th surgery and he's only 6 months old!!! The neurosurgeon said that Dr. Elton would be in around 7am to talk with us. When he arrived I just broke down. I didn't want to ever have to see him again! Gretchin hugged me while Elton told us the seriousness of what Rayden was facing. He said if there is an infection in the CSF that it will travel into the shunt and it will become infected as well. Therefore he will need surgery to take out the shunt, antibiotics to clear up the infection and a second surgery to put in a new shunt once the infection is clear.

Antibiotics can stop the infection in the CSF but since the shunt is not a living thing, antibiotics cannot reach all of the bacteria stuck to it. Even if the infection in the CSF clears up, it may come back if the shunt stays infected. While they are waiting for the infection to clear Rayden will be placed on an external ventricular drain (EVD). An EVD is a temporary drain that drains cerebro-spinal fluid (CSF) from the lateral ventricles in the center of the brain to an external reservoir. The EVD consists of a thin plastic tube (catheter) which is placed into the ventricles of the brain and connected to an external drainage system. They will take a culture sample every three days. When they get two consecutive clean cultures they will be able to replace his shunt. This means Rayden will remain in the PICU for at LEAST 6 days, if not more.

11:30 am-We are all too familiar with the process of surgery now. But no matter how many times we do this, it will never be easy. I was already crying when the anesthesiologist came to take Rayden to the OR. I can't stand the thought of him having to have brain surgery over and over. Michael and I just stood there in the waiting room holding each other and saying a prayer for Rayden. God, please protect our little precious gift.

Michael and I went back to Rayden's room on the 6th floor to find Nanny, Papa, Alex, and Pastor Brad waiting for us. We all prayed for Rayden and gathered our belonging to move to the PICU. On our way to the PICU waiting room we met Dr. Elton in the hall. He reported that Rayden came through the surgery just fine and we could see him soon.

1:00 pm- Michael and I finally got to see Rayden. As soon as I walked in I could hear him crying and said "That's my baby." The nurses laughed at the thought of me being able to identify his cry through all of that noise, but I was right. Rayden's eyes were swollen. He seemed relieved to hear our voices though. He calmed down and closed his eyes as we talked to him and held his little hands. I noticed they cut A LOT of his hair off and the EVD was protruding out of the back of his head. It was a scary sight at first. I will never get used to seeing my baby hooked up to machines. The EVD relieves elevated intracranial pressure.
It drains fluid from the ventricles of the brain keeping them decompressed. It has to be observed closely with neuro checks every hour. The drain is set to 15cm above the level of the tip of his ear. CSF flows out into the measuring chamber and then drips into a bag. With all of this having to be set just right Rayden has to stay pretty stationary. We can't get him out of the crib or even sit him up. If he moves too much it will dump a lot of CSF causing him to have a massive head ache.

4:00pm- They allowed us to try and feed Rayden some milk. Although we couldn't get him out of the crib, we did prop him up on my pillow. He only ate about 4 oz. but that seemed to make him feel so much better. He even started playing a little bit with the cords.

The Infectious Disease team informed us that shunt infection is usually caused by a person's own bacterial organisms not from other children or adults who are sick. The most common infection is a skin bacteria (Staphylococcus epidermidis). It is normally found on the surface of a person's skin and in the sweat glands and hair follicles deep within the skin. This type of infection is most likely seem 1-2 months after surgery, but can occur up to 6 months. Rayden's last surgery was 2 months ago. They have Rayden on two very strong intravenous antibiotics. When they identify the specific organism they hope to eliminate one of the antibiotics.