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If you want to know if you need to get a second opinion before giving consent to a PEG tube, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, we often get asked whether families should give consent to a PEG (Percutaneous Endoscopic Gastrostomy) tube when they have their loved ones in ICU. We recommend in a situation like that that most times, don’t give consent to a PEG tube. It depends a little bit on the country you’re in. But the question today, should you get a second opinion? Absolutely. You absolutely should.

So, I need to break it down today almost by country-by-country. Let’s just start with the U.S. Many patients in ICU that end up with a tracheostomy, the ICU teams often recommend the PEG tube at the same time, and we strongly recommend against that.

Here is the reason why. When patients in the U.S. have a tracheostomy and a PEG, ICUs want to send them to an LTAC (Long Term Acute Care) facility as quickly as possible, and patients and families don’t even know that this is coming. It’s often a bait and switch tactic where ICU say, “Well, your loved one needs a tracheostomy and the PEG to be weaned off the ventilator”.

Whilst a tracheostomy will definitely help with weaning off a ventilator, a PEG tube does not. I will also point towards a research paper in the written version of this blog where you can see that PEG tubes have more adverse events than nasogastric tubes. So, it’s evidence-based actually what I’m saying here.

Also, when you give consent to a tracheostomy but not a PEG tube in the U.S., in particular, many LTACs can’t take your loved one. They are not skilled to look after a nasogastric tube instead of a PEG tube.  So, that should also tell you something about the skill level your loved one will go to if they go to an LTAC. LTACs have very poor staffing levels, they don’t really have the skills to wean patients off the ventilator and tracheostomy.

A PEG tube simply is not necessary to wean a patient off a ventilator. Absolutely not. I’ll give you a case in point. I’ve worked in critical care for nearly 25 years in three different countries where I also work as a nurse unit manager in intensive care. I’ve been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013.

We have saved many lives with our consulting and advocacy. You can verify that on our testimonial section or on our podcast section where we have interviewed our clients who verify our work.

So, let’s look at countries like Australia or the U.K. Let’s look at those ICUs. How many patients in those ICUs end up with a PEG tube? Not many because patients get weaned in ICU with a tracheostomy, and there is no PEG tube necessary. A nasogastric tube is perfectly fine. I’ve seen patients with nasogastric tubes for up to 6 months, and they can be successfully weaned off the ventilator.

Now, here is when patients do need a PEG tube, patients do need a PEG tube if they can’t be weaned off the ventilator and the tracheostomy or if they can’t be weaned off the tracheostomy and they can’t swallow and drink, that’s when patients need to be having a PEG tube. So, I’m not categorically saying here that PEG tubes are necessary, but you absolutely need to get a second opinion before you give consent to a PEG tube.

So, for example, some of you may know that we are also running the service Intensive Care at Home and you can find more information at intensivecareathome.com. Most of our clients in a home care setting that are on ventilators and have tracheostomies or that are on ventilators without a tracheostomy or that have a tracheostomy but are not ventilated, most of them actually have a PEG tube.

However, they’ve shown often over many years. I’m talking about years. I’m not talking about weeks or even months that they can’t be weaned off the ventilator, they can’t be weaned off the tracheostomy, they have shown over weeks, months, and years that they can’t swallow. So, that is a clear indication for a PEG tube, but you can see the devil is in the detail here.

What I’m saying here is you should absolutely not give consent to a PEG tube prematurely. If ICU asks you after two weeks, four weeks in ICU to give consent to a tracheostomy and the PEG tube, the consent to a PEG tube in particular is premature. Consent to a tracheostomy can probably safely give after two weeks of the inability to wean off the ventilator.

I’ve done a video a couple of days ago, “Do you need a second opinion before giving consent to a tracheostomy?” The answer is absolutely yes. You can check out the video there.

But, generally speaking, for anything in ICU, you do need a second opinion. It’s a once in a lifetime situation, but you can’t really afford to get wrong. So, you always need to get a second opinion regardless. But for PEG tubes, in particular, especially for our audience in the U.S., you absolutely need to get a second opinion. You need to avoid going to LTAC at all costs because it’s a disaster area. It’s a disaster area.

So, I hope that helps you answering that question and not give consent to a PEG prematurely.

Do your research don’t do it if you’re in the U.S. and if you’re in other countries, do your research. Follow-on services after ICU, PEG tubes or nasogastric tubes be looked after in those environments wherever your loved one might go next. You absolutely have to do your research.

Because we get so many questions from families in intensive care, that’s why we 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 intensivecaresuppot.org directly. In the membership, you could 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 your loved one gets best care and treatment.

Furthermore, 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 can’t afford to get wrong. I make sure you’re in a position that you can anticipate what is happening, that you know what questions to ask, what to look for, how to manage intensive care teams. 99.9% of families in intensive care have no idea that you can manage intensive care teams, but you need to know what you’re doing. I also talk to doctors and nurses directly on your behalf if you want me to do that. I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care or I can set you up with asking the right questions. 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 a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

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

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. You will get notification for the YouTube live if you’re a subscriber to my YouTube channel or if you are subscriber to our email newsletter at intensivecarehotline.com.

If you want to leave us a small donation at the super chat button on YouTube, that would be much appreciated. It will help us to create as many videos as possible for families in intensive care. If you want your email read out or your question answered quickly, also leave a small donation and I will get to it in the next couple of days. I still have emails sitting in my email inbox from last year that I haven’t even addressed yet. So, I’m working my way through them step-by-step.

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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