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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another question answered for our members from intensivecaresupport.org, where we have a membership for families of critically ill patients.

Now, I’m reading out a question from one of our members from last year and all names are changed. Everything is anonymous here and how we answered the question so you can get an idea of what you get if you are becoming a member for our membership of families of critically ill patients at intensivecaresupport.org.

So, here’s an email from one of our members, “Hi, Patrik, we spoke over the phone a couple of days ago and you’ve been helping me to get answers regarding my grandmother and I thank you very much for that.

So, I have let the nurses and the doctors know as of two days ago, we want to proceed with a tracheostomy and not with a PEG (Percutaneous Endoscopic Gastrostomy) tube. Since then, every time I call or visit my grandma, the topic is brought up. Every nurse is asking me why and is telling me that it’s in my grandma’s best interest. However, I have simply told them we are just not ready to have that procedure done for my grandma.

Earlier today in ICU, the doctor called asking why we didn’t want the PEG tube done and if we had any concerns.

My question is if they find an LTAC (Long Term Acute Care) who would take her with a nasogastric tube, what would I do to possibly keep her in ICU? Would I then ask for a discharge policy? I would also like to add that the tracheostomy has not been done yet and it probably won’t be done until Monday or Tuesday because from what we were told, she needs to be off the Plavix for 2 to 5 days. Today, was Day 1 of her not receiving the Plavix.”

So, this is a client we worked with for a long time, last year in the U.S. Obviously, whenever I speak about LTAC, it’s very U.S. specific. There are no LTACs in other countries such as where most of our other clients are such as in Australia or in the U.K.

Anyway, let’s get back to what we wrote back to her at the time, “In regard to your question…” I will elaborate on more than just what we responded at the time in an email to our client and our member. I will elaborate more in so you can understand the context of it all.

“My question is if they find an LTAC who would take her with a nasogastric tube?” An LTAC will take patients if they have a PEG tube. If they insist on LTAC, ask them about the discharge policy of the hospital because it says there that the patient cannot transfer to any facility without a patient or family consent.

We have not really seen that LTACs take patients with a nasogastric tube. We haven’t really seen that which brings me back to that LTACs are not qualified to look after ventilated patients with a tracheostomy. They can’t look after a nasogastric tube, how can they possibly look after a ventilator and a tracheostomy? Let that sink in and think about it. I will talk more about why no PEG tube and continue with the nasogastric tube in those situations.

Let’s carry on with the email, “In regard to your other question, “What would I do to possibly keep her in ICU?” Well, if your grandma is still with nasogastric tube, then she can still stay in the ICU because LTAC usually will not accept a patient who is still on a nasogastric tube or to further help you in terms of keeping your grandmother in ICU. I would send you a list of questions for us to more concisely understand your grandmother’s case.

We have done that, we have sent her a list of questions which I won’t go into too much detail now because if you go to our website and you type into the chat pad, “What questions to ask when your loved one is critically ill in intensive care?”, you get a whole list of questions. But I want to elaborate more on how to steer situations like that if you are in a similar situation, especially if you are watching this and you’re in the U.S., where there’s the threat of your loved one going to LTAC after they had a tracheostomy.

So, here is the issue with the PEG tube and then going to LTAC. A patient on a ventilator with a breathing tube or with a tracheostomy can be getting nutrition with a nasogastric tube in the nose. There’s absolutely no need for a PEG tube. So, let me explain why.

I’ve looked after patients in ICU, I worked in ICU for over 20 years in three different countries, worked as a nurse unit manager in ICU for over five years. So, I’m talking about this with lots of experience and there is no need for a PEG tube, not if the goal is to wean your loved one off the ventilator.

If your loved one can’t be weaned off a ventilator full stop, can’t be weaned off the tracheostomy full stop, then a PEG tube should be considered. But even if your loved one can’t be weaned off the ventilator and the threat is for your loved one to go to an LTAC, do not give consent to a PEG tube.

Now, a PEG tube has the perception of a permanency in hospitals or in health care in general, which means once a patient has a PEG, it’s been perceived as a permanent thing. So, no one will even bother to help your loved one getting to eat and drink again. Now, you don’t want that.

A nasogastric tube has the perception of it’s a temporary device, a temporary thing. So therefore, the goal is for a loved one to eat and drink again. Therefore, all signs and all efforts need to be made to get your loved one off the ventilator, off the tracheostomy, off the nasogastric tube. Let them eat and drink again.  So, you can see that a PEG tube is only detrimental for your loved one if you give consent to that.

Now, also a nasogastric tube can stay in for up to 6 months. A PEG tube, also, that’s surgery. It’s a surgical case or surgical procedure, I should say. It’s a surgical procedure. Why would you do surgery? Potentially with a general anesthetic, not necessary.

Once again, LTACs are not equipped to look after ventilated and tracheotomy patients. ICUs will try and “sell” you on LTACs saying, “Oh, they’re the specialists on weaning patients off a ventilator and a tracheostomy. Look up the online reviews. Talk to families who have loved ones in LTAC. But when you look up online reviews, you get the picture pretty quickly.

Now, I am not opposed to a tracheostomy. A tracheostomy has the time in its place. What you need to do first and foremost is you need to check if they are doing everything beyond the shadow of a doubt in ICU to help your loved one to avoid the tracheostomy and help your loved one getting off the ventilator, and the breathing tube. Again, I’ve written an article and made a video about it, “How to wean a critically ill patient off the ventilator and the breathing tube in intensive care?” Go and check that out.

Also coming back to LTACs, what we see over and over again when working with clients one-on-one is when they go to LTAC, ICU tells them, “We got to go to LTAC, especially some weaning patients off the ventilator and the tracheostomy.” They can’t. The next thing you know, your loved one is only there for two weeks and then they say, “Oh, we got to send your loved one to a skilled nursing facility or to a nursing home. It’s going from bad to worse.

That’s why you need to stand firm and keep your loved one in ICU because ICUs know how to wean patients off the ventilator and the tracheostomy. All the skill sets, all the resources are there. So, I hope that helps explain the situation. I hope that helps you understand how you need to position yourself, what questions you need to ask.

Of course, if you want to become a member and get access to me and my team, 24 hours a day, in a membership area and via email and have your questions answered when you have a loved one in intensive care, go to intensivecaresupport.org and sign up for a membership.

I also offer one-on-one consulting advocacy over the phone, via Zoom, via Skype, WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly in intensive care. I can represent you in family meetings and I’ve done so many, many times successfully. We’ve saved many lives by simply advocating for our clients when they have loved ones in intensive care. You can look that up on our testimonial section. You can also look up some podcasts with client interviews.

Now, we also provide medical record reviews in real time if you need a medical record review in real time because you want a second opinion, please contact us and we can do that for you in real time. We also offer medical record reviews after intensive care if you have unanswered questions, need closure, or you’re suspecting medical negligence, please contact us as well.

If you have any questions about what we exactly do and you want to have a quick chat, have a look 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] with your questions.

If you are finding these videos valuable, please subscribe to my YouTube channel, hit the like button, hit the notification bell, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have.

Thanks for watching.

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

Take care for now.