Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

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

So, today’s tip is about, “What to do when you’re in the early stages of an ICU admission?” So, here’s the situation with a client who is currently in ICU since the 4th of November. At the time of this recording, today is the 2nd of December.

So, client’s 78-year-old mother ended up in ICU with an aspiration pneumonia and they felt like she would be struggling of weaning off the ventilator. Therefore, the ICU team told the family that they think she needs a PEG tube in order to maintain nutrition.

Now, the family gave consent to the PEG tube early on. The PEG tube is basically a feeding tube that’s being inserted with a surgical procedure through the abdomen into the stomach to enable enteral nutrition.

Now, you have heard me saying in countless videos here that the biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care.

So, case in point, there’s absolutely no need for a PEG tube. No need for a PEG tube. The only need for a PEG tube is when someone can’t come off the ventilator beyond the shadow of a doubt and has a tracheostomy, has some neurological condition, cerebral palsy motor neuron disease, C1, C2 spinal injuries. That’s when patients unfortunately need a PEG but your mom being in ICU for less than 7 days is absolutely no indication for a PEG tube whatsoever.

She can have nutrition with a nasogastric tube and if she’s intubated, she can have nutrition with an orogastric tube. There’s no surgery needed for that. Whereas a PEG tube is a surgical procedure. There’s no need for that. There are risks that come with surgical procedures. It’s also risky to put in a nasogastric tube, but it’s less risky.

Also, a PEG tube gives hospital staff and nursing home staffs and health professionals in general a perception of permanency. So, what I mean by that is when someone has a PEG tube, there is the perception in hospitals or nursing homes or in those places that this person will never eat or drink again ever. Now, that’s not the perception you want to have for your family member.

Whereas if someone has a nasogastric tube or an orogastric tube, everyone knows, health professionals know that this is a temporary thing to give nutrition temporarily and therefore efforts need to be made to start a patient to eat and drink again to avoid the PEG tube.

In this instance, the hospital did it the other way around. They were selling to the family saying that, “Oh, she needs a PEG tube because she needs nutrition.” She doesn’t need a PEG tube to get nutrition. No need to use a PEG tube. No need to do surgery for a PEG tube to get nutrition. That’s absolute nonsense.

In the meantime, when the client first contacted us, their mother also had a tracheostomy. Now, here is the issue. Her mother has a tracheostomy and the PEG. She’s actually in the U.S. so that means in the U.S., in particular, a patient in ICU with a tracheostomy and the PEG is “paid for LTACs.” If an ICU rings up an LTAC and says, “Hey, we have a patient here with a tracheostomy and the PEG, do you want to take them?” LTACs will jump on those patients and get them into LTAC.

Now, I’ve made countless videos about LTAC, how bad they are, how poor they are. Just look up their online reviews and you know what I’m talking about.

So therefore, for this lady to have a tracheostomy and a PEG is not a good position to be in. Tracheostomy might be the right thing to do, but definitely not a PEG. Never ever. Besides, the exceptions that I told you in the beginning, if someone can’t be wean off the ventilator beyond the shadow of a doubt, but not just after a couple of weeks.

The goal of the hospital should be to wean this lady off the ventilator as quickly as possible, not to talk about PEG tubes and LTACs. They should be talking about, “How do we get this lady off the ventilator?” That should be the conversation to be had. If you look up the online reviews, weaning off a ventilator is not going to happen in an LTAC.

You must ask better questions and you also need to understand that the biggest challenge for families is in intensive care simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care.

This is a classical example, but this is has happened again here. I want everyone to watch as many videos here as possible cause if, let’s just say, your loved one needs a tracheostomy but doesn’t have a PEG, you hold all the cards where your loved one is going.

If they don’t have a PEG and the tracheostomy your loved one won’t go into an LTAC because LTACs won’t take them without a PEG tube. That should tell you everything about the quality of an LTAC. If they can’t take a patient without a PEG tube, that should tell you everything you need to know about the quality of LTACs. Think about that.

Now, that is my quick tip for today.

If you have a loved one in intensive care and you need help, we actually have a membership for families of critically ill patients in intensive care. You can get access to our membership for families of critically ill patients in intensive care at intensivecarehotline.com if you click on the membership link or by going to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in a membership area and via email and we answer all questions, intensive care related. In the membership, there’s also videos and e-books available, not publicly available, but you get them as a member. Very specific and unique e-books for our member.

Now, in case you’re wondering what makes me qualified to offer a membership for families in intensive care, I am a critical care nurse and I have worked in intensive care/critical care for over 20 years in three different countries. I have also worked as a nurse unit manager in intensive care for over five years. I have been consulting and advocating for families in intensive care for the last 10 years all over the world as part of my intensivecarehotline.com consulting and advocacy service for families in intensive care.

Now, I also offer one-on-one consulting and advocacy for families in intensive care. I talk to you over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I also talk to doctors and nurses directly and I ask all the questions you haven’t even considered asking but must be asked so that you make informed decisions, have peace of mind, control, power, and influence.

I also represent you in family meetings with intensive care teams. Now, if you’ve been in a family meeting with intensive care teams, you know exactly why I’m recommending here that you have me there as clinical and advocacy representation because otherwise, they might walk all over you. That’s what I’m here for to help you, once again, making sure your loved one gets best care and treatment, gets best outcomes, and you can make informed decisions, have peace of mind, control, power, and influence.

Now, we also offer medical record reviews in a real time so that you can get a second opinion in real time that in combination with my consulting advocacy, especially all the bonus rocket fuel for you and your family to make informed decisions, have peace of mind, control, power, and influence. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

Now, 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 and what questions and insights you have from this video, share the video with your friends and families.

Thanks for watching.

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

Take care for now.