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Quick Tip for Families in Intensive Care: Is Changing the Inner Cannula for My Husband’s Tracheostomy Twice a Day Sufficient?

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

Today’s tip is again, answering a question from one of our members in our membership for families of critically ill patients in intensive care at intensivecarehotline.com. You can go to our membership section there or you can go directly to intensivecaresupport.org.

So, let’s read out a question from one of our members who says,

“Hi Patrik and Team,

My husband’s tube feed is from a pump. He gets 80 mls of formula per hour and 100 mls of water every eight hours. I was informed by the dietician that he was getting Banatrol in his tube feeds, but they intend to stop it since his stool is now okay.

Today, he worked with a speech pathologist and a physical therapist. He sat up at the side of the bed. I know they should be working with him more than once a week. I requested the debridement of his wound, so the doctor will get back to me about this. I requested a transfer to another hospital, or to be discharged for home, but I’m getting the run around.

He has good breathing, no fevers. His inner cannula of the tracheostomy is changed two times a day. Is this sufficient? He was given Melatonin last night to help him sleep. I didn’t like the side effects on him, and he has no problem sleeping. He was alert, responsive and mobilized today, but it should be every day. Thanks for your response.”

So here is our response.

I hope that you are well, thank you for your email and the updates about your husband. We are very glad to know that your husband is doing well with his breathing, has no fever, and is tolerating his tube feeds. Those are good signs of progress. We pray and hope that your husband finds strength with each new day and brings him closer to a full and speedy recovery.

If your husband has no problem with his stool, no diarrhea or loose stools, the Banatrol can be stopped or discontinued because Banatrol thickens the stool and helps to reduce the bacteria in the stool. It is nutritional support for the management of diarrhea or loose and watery stools.

To improve your husband with his bowel problems, you can also include bananas in his feeds. You can have it blenderized and mixed with his feeding formula because the banana is the best aid during loose motions, also improves bowel irregularity, and the potassium in bananas is good for your husband’s heart and blood pressure.

If your husband has a good tolerance to feeds, ask the doctor and dietician to assess if it is possible for your husband’s feeding to be shifted gradually to bolus or asepto syringe feeding. For example, 240 mls of feeds every 3 hours or 160 mls of feeds every 2 hours as your husband can tolerate it.

Once started with bolus feeding, aspiration precautions are to be observed. Of course, bolus feeds give time for the stomach to rest more convenient for the patient with no need for a feeding pump and freedom of movement for your husband. If he tolerates the volume, then it can gradually increase accordingly.

It is very good to know that your husband’s participating in his regular sessions with a physical therapist and speech language pathologist. These regular therapies and exercises will greatly help your husband with his fast recovery and avoid further complications like contractures, nerve paralysis, et cetera.

Was his wound was assessed by the doctor and recommended for a debridement? To promote wound healing, daily dressings of the wound by the wound care nurse must be done aseptically and prescribed medicines such as antibiotic cream, ointment, surgical, supra tule/ bactigras dressings to apply and placed, strict prevention of infections by doing the hand washing, wearing of gloves, et cetera and nutritious diet/feeding formula to be prescribed by a dietitian that helps in your husband’s wound healing, body repair and restoration.

Now, I would also suggest that with him having diarrhea, there’s a very high risk of an infection when that stool might be entering the pressure area and that could cause sepsis. So, be very careful there that they really maintain good hygiene and give him very good nursing care.

Now, you requested transfer to another hospital, or a home discharge. Has your husband been assessed by the doctor and is fit to be discharged? Now, I do know that your husband still has a tracheostomy. Therefore, he can’t really go home unless he has 24-hour intensive care nurses at home because he needs someone with him 24 hours a day that is tracheostomy competent.

Now, you also asked if changing the inner cannula twice a day is sufficient. Look, it really depends. So, when the inner cannula is changed, someone needs to look at, is there sputum blood? Is it soiled? So, if the inner cannula changed twice a day, then and if it’s not soiled that is sufficient.

Now, if the inner cannula is changed twice a day and it’s heavily soiled and potentially narrowed in diameter, then it’s not often enough. The risk of a sputum plug then is real.

Therefore, is it often enough to change it twice a day? It all depends. And your husband should not be discharged without having 24 hour nursing care at home with critical care nurses that are tracheotomy competent. So, you can’t be discharging your husband prematurely here. Otherwise, he’ll just bounce back into hospital.

So also, are your husband’s vital signs normal? And are they maintained, have they recently checked for his blood’s white cell count, red blood cells, electrolytes, et cetera. Are the results of blood investigation and culture results good and normal? Has he completed his antibiotic treatment? We are looking forward to your response and it is to be continued here with another question from our member.

Now, if you want to become a member and get the same questions answered or similar questions answered when you have a loved one in intensive care, and you want to have access to me and my team, then go to our intensivecarehotline.com website and go to our membership section on the website and sign up for our membership of for families of critically ill patients.

You can also access the membership directly through intensivecaresupport.org. There 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.

I also offer one-on-one consulting and advocacy over the phone, via Skype, via Zoom, via WhatsApp, whichever medium works best for you. And I talk to doctors and nurses directly. I also represent you in family meetings with intensive care teams. And I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care, critically ill so that you can make informed decisions, have peace of mind, control, power and influence.

We also offer medical record reviews in real time so that you, once again, can get real data evaluation in real time and the second opinion in real time once again, so that you can make informed decisions, have peace of mind, control, power and influence. Now, we also offer medical record review after intensive care if you have unanswered questions, if you are simply needing closure or if you are simply suspecting medical negligence.

For any of these services, contact us at intensivecarehotline.com, call us on one of the numbers on the top of our website or send us an email to [email protected].

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, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thanks 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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