Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So today’s tip is about, should a tracheostomy and a PEG be done at the same time. So a lot of patients in intensive care that need a tracheostomy or a trache also often have a PEG tube at the same time. A PEG tube is a feeding tube that’s basically inserted in the stomach through the abdominal wall.
Now, from my experience, a PEG and a tracheostomy do not have to be done at the same time. Although I know from experience that hospitals and ICUs are often trying to push families in intensive care to agree to do a PEG and a tracheostomy at the same time.
Now I tell you my point of view, from my experience now, number one, they don’t have to be done at the same time. I even oppose doing them at the same time, and I’ll tell you why.
So when someone is ventilated with a breathing tube or with a tracheostomy, they can’t eat and they need to be fed and they need to have nutrition. Now, when someone is first being put on a ventilator and intubated patients often have an orogastric tube or a nasogastric tube, that’s basically inserted through the nose or through the mouth and it’s going into the stomach and enteral feeding can be commenced through that tube.
When someone is having a tracheostomy, they still need to continue to be fed because they’re still not in a position to take oral food or oral supplements.
Now, when someone is on a tracheostomy and ventilated, they can continue to receive nutrition through a nasogastric tube or through an orogastric tube. However, a nasogastric tube is definitely preferred. An orogastric tube can be easily dislocated and a nasogastric tube is a more stable feeding tube.
Now, why am I opposed to doing a PEG simultaneously with a tracheostomy? The reason I’m opposed to it is, a PEG is a permanent or it’s often used as a permanent feeding tube. Now the goal for someone with a tracheostomy and the ventilator should be to wean them off the tracheostomy and the ventilation. That should be the goal, always.
If you’re having a PEG tube, it makes people complacent. It stops people from even trying to have oral intake. It stops people from weaning people off the ventilator and the tracheostomy.
A PEG is often a permanent arrangement, whereas a nasogastric tube, it’s in the nose. It’s probably uncomfortable. Don’t get me wrong. You might have to change it here and there to not get pressure sores in the nose, but there’s a real incentive to wean patients off the ventilator and tracheostomy if you’re not having a PEG, because you know, you need to get people back on their feet.
You need to get people to start to eat and drink again. A PEG is a permanent arrangement. Anybody that lives with ventilation and tracheostomy long-term over years, yes, they need to have a PEG. There is no doubt about that.
But if you’re starting with a PEG, the minute you, inserting a tracheostomy, I do strongly believe that it makes people complacent and not trying hard enough to get people off the ventilator and tracheostomy with a PEG.
That is my quick tip for today. Like this video, comment down below your thoughts and what questions you want to have answered and subscribe to my YouTube channel for any updates for families in intensive care.
This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days.