June 9

 Midafternoon, Brian's doctor called me with news that Brian's bilirubin count increased to 9 mg/dL. He had a surgeon next to him wanting permission to replace one of the cannulas (tube that carries blood to and from Brian's body and ECMO machine). They suspected that he may have a blood clot in the tube and wanted to replace the tube to give him better flow. It was anticipated to be a quick procedure that would be done in his room. They wanted to switch the cannula from one side of his groin to the other. The procedure went smoothly. His doctor reported that Brian handled the procedure well. There was more than one blood clot that was found in the cannula. Unfortunately, one of the blood clots was at the end of the cannula and did not fully come out. The doctors suspect that the blood clot has traveled to one of his lungs. There isn't a way to safely retrieve the blood clot. What they can do is increase his blood-thinning medication to help thin it out. Depending on what Brian's bilirubin count looks like tomorrow, they may try and switch out the second cannula that is in his neck to try and clear out any potential blood clot(s) that may be blocking the cannula and decreasing the machine's ability to oxygenate his blood. 

The risk with increasing Brian's blood-thinner medication is that Brian still has bleeding in his nose. He is being given blood transfusions as needed and will need more as the blood-thinners are increased. Between blood clots and bleeding, treating the blood clots with blood-thinners makes the most sense.