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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So today, I have an email from one of our members, I’m going to read out and then I will obviously critique it.

“Hi Patrik,

Your information is very helpful. I found several articles online also and see that what the doctor in ICU was telling me was not true that Jim can get up and walk with a nasogastric tube in and that it doesn’t have to be removed each time for physical therapy or walking. People even go to restaurants and do normal activities with the nasogastric tube in and can even eat and drink with it.”

So, I did make a video a few days ago where, again, the ICU was trying to push one of our clients to consent to a PEG (Percutaneous Endoscopic Gastrostomy) tube for one of their family members in ICU, for our client’s husband, and that’s just simply not appropriate.

The doctor was saying that clients or patients can only be mobilized with a PEG tube and not with a nasogastric tube. What a whole lot of crap, excuse my language, but that’s simply not true. It’s a lie, as a matter of fact. Plenty of patients get mobilized with a nasogastric tube. So, it’s just a matter of mindset and having the right skills and expertise available to make that happen.

So, she actually continues, “And my husband can practice swallowing his saliva and the speech pathologist can keep trying to help him swallow. If there is a cuff on the tracheostomy tube, I read that makes swallowing difficult. If not, he can put a finger over the hole and begin practicing talking, but then also inflated or deflated cuffs. Either way, it can make pronunciation or speaking still difficult.

The airway being blocked, I guess that is why the doctor said an airway needs to be opened up. The yellow mucus pus discharge seems to be the real problem making progress weaning off the tracheostomy and the nasogastric tube. As soon as he can get back to breathing and eating on his own, he won’t need those tubes anymore.”

So that is all accurate what you’re saying here, not only with the nasogastric tube, but you can practice swallowing saliva, and the speech pathologist can help him try swallow. Yes, absolutely. The speech pathologist needs to try doing some swallowing tests.

Now, in order to do the swallowing test, the cuff needs to be down. You have correctly pointed out that the tracheostomy cuff will make it difficult to swallow. Well, it almost makes it impossible to swallow, that is the whole purpose of a cuff. It actually helps to prevent an aspiration pneumonia. 

It helps to prevent aspiration pneumonia because the airway is sealed. The tracheostomy sits in the back of the throat and basically seals off the airway, the lungs, i.e., the block or the balloon disables saliva to drip down into the lungs. So, that’s on the one hand, that’s a good thing when patients can’t swallow.

On the other hand, it’s not such a good thing if people are ready to swallow again, and if people need to be weaned off the tracheostomy. So, the cuff is the first thing that needs to then go down to assess swallowing.

Also, whilst the cuff is up, the vocal cords are paralyzed and once the vocal cords are paralyzed, speaking is not possible. So then again, once the cuff is down, yes, you could put your finger on the hole and then that might activate speaking, assuming people can mouth words or a speaking mouth like a Passy-Muir speaking valve is then another device to get practicing to talk again.

Now, with the yellow mucus pus discharge and seems to be the real problem making progress weaning off the tracheostomy and the nasogastric tube. Yes, that might be. So maybe too many secretions are still the issue. If too many secretions are still the issue, there’s a number of things that can be done. Once again, mobilization will help. Just mobilize it even more, get it all out, clear it all out and then hopefully, it gets less over time.

Also, if you’re doing more suction, then you’re also stimulating. So, the less frequently you’re suctioning, the better it is, the higher chances you can remove a tracheostomy tube eventually. Other things that might be done is atropine drops and potentially glycopyrrolate to reduce the mucus. So, I hope that helps.

One of the takeaways again today is do not give consent to a PEG tube. Once again, there is exceptions to the rule. If someone cannot be weaned off the ventilator beyond the shadow of a doubt, maybe they have a spinal injury, they have been ventilated for months, years on end, but that is not the case here. If your loved one has a chance to get off the ventilator, you should not give consent to a PEG tube full stop.

So, that is my quick tip for today.

I have worked in critical care for nearly 25 years in three different countries where I worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013.

I can confidently and without any hint of exaggeration say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section or on our intensivecarehotline.com podcast section where we’ve done client interviews, and that’s one of the many reasons why we’ve created a membership for families of critically ill patients in intensive care.

You can become a member if you go to intensivecarehotline.com, if you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email and we answer all questions intensive care related.

In the membership, you also have exclusive access to 21 e-books and 21 videos that I have personally written and recorded that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure you can influence decision making fast so that your loved one gets best care and treatment.

I also do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong. I also talk to doctors and nurses directly if you want me to do that. I ask all the questions that you haven’t even considered asking but must be asked, engaging in that one-on-one dialogue with another intensive care specialist so that they know you have someone on your team that speaks their language so that they can’t hide. I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get this crucial second opinion in real time. We also offer medical record reviews after intensive care so that you can get closure, if you have any questions, or if you are suspecting medical negligence, we can find your answers there.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, comment below what you want to see next, what questions and insights you have, share this video with your friends and families. I also do a weekly YouTube live where I answer your questions live on the show.

If you want your video done here quickly, if you have an email question and you want it done here in a video, leave a donation here on the super chat button and I will read out your email in the next couple of days, answer your questions. Leave a donation anyway to support the work that we are doing.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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