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

Today, I have an email from Peter who says, “I have an inquiry regarding the next steps for my mother’s care.

Hi Patrik,

My name is Peter and I’m reaching out to you regarding the current medical situation of my mother. She’s 71 years of age, has been under the care of the… and I’m not naming the name of the hospital, in ICU for 3 months, recovering from complications following quadruple bypass surgery. Notably, a dislodged PEG (Percutaneous Endoscopic Gastrostomy) feeding tube resulted in the development of necrotizing flesh bacteria pathogens. Medical team now deems her fit for transfer to a long-term care acute rehab facility. Her insurance coverage includes Blue Cross Blue Shield, PPO, Medicare, and Medicaid.

After thorough research and coming across very informative videos by Patrik Hutzel and intensivecarehotline.com, I have reservations about whether the proposed rehab facility from the hospital is the most suitable next step for my mother’s recovery. I kindly request your assistance in discussing alternative options in determining the next most beneficial course of action for my mom’s continued care.”

This is actually an email that has been a while back because we actually work with this client one-on-one. I’ve changed the client’s name.

So, let me break this down for you because a lot of you watching this, especially if you are in the United States will probably think, “Oh, my mom, my dad, my spouse is in a similar situation. What should I do?” Well, the first thing here is this, a lot of ICUs when it comes to ventilation and tracheostomy, because Peter’s mother has been ventilated with the tracheostomy. We work with Peter’s one-on-one, that’s obviously why I know all the details.

What happened was that, by him giving consent early on to a PEG tube, which we strongly disagree to, and I will go more into detail in a minute why. This is when some of the complications developed. A PEG tube should not be done prematurely. The only time a PEG tube is really needed is if patients are not coming off a ventilator and a tracheostomy in the very long-term. That means for example, if someone has, God forbid, a spinal injury C1, C2, C3, motor neuron disease, cerebral palsy, and other conditions where patients can’t be weaned off the ventilator beyond the shadow of the doubt. That was definitely not the case with Peter’s mom because she actually did come off the ventilator during the course when we were working with Peter.

So, that’s why I am so adamant of not rushing into a PEG tube. Nasogastric tube is perfectly fine. It can stay in up to 6 months. Yes, it has to be changed frequently but the bottom line is a PEG tube is surgery, whereas a nasogastric tube doesn’t require surgery and really what a PEG tube enables the hospital to do if someone is ventilator dependent with a tracheostomy is that it enables them to send your family member out.

In this situation, they wanted to send Peter’s mom to rehab but obviously he had reservations and rightly, so. A lot of patients that go to rehab, go to LTAC, potentially even subacute or a SNF (Skilled Nursing Facility) and bounce back into ICU in no time anyway. So, you have to be very careful.

I’ve done countless of videos, “Why not to do a PEG tube”. If you’re in doubt, like I said, there are situations where a PEG tube is the right approach. It’s actually the exception, not the rule. Whereas now, many ICUs, especially in the U.S., it’s almost a rule that after a few days in ICU on a ventilator, rather than weaning patients off the ventilator and the breathing tube, they keep them sedated for too long, put a tracheostomy in, put it a PEG in, and then send them to LTAC and there’s nothing good happening in LTAC.

Again, I’ve done countless of videos and case studies from clients who have loved ones in LTAC and are literally begging us to help them to get them back to ICU, which is just what we’ve done recently. We’ve helped a client to go from LTAC back to ICU with our advocacy.

So, the bottom line, the take home message here is don’t do a PEG tube. Tracheostomy has its time and its place. Sometimes a tracheostomy can be a vehicle to get someone off the ventilator quicker because you can stop sedation or minimize sedation, minimize opiates, tracheostomy can be a very good conduit to get someone off the ventilator. Can be exceptionally good.

But if it’s in combination with the PEG, it almost implies that it’s taking a long time to wean someone of a ventilator whereas if you leave a nasogastric tube in, it gives everyone the perception of a temporary solution. “We got to get rid of the nasogastric tube, we got to get rid of the tracheostomy we got to get rid of the ventilator.” Whereas if someone is having a trach and the PEG, it often gives the perception of this is long-term. Well, why would you want to have a tracheostomy and the PEG long-term? There’s no sense in that.

So, the bottom line is this. Do not go to LTAC, do not go to rehab, do not go to skilled nursing facility if you don’t feel your family member is ready for it. We are very happy to give you a second opinion here. We’re very happy to guide you through things, step-by-step, which is what we’ve done with Peter here. We kept his mom in ICU for as long as needed until she came off the ventilator and the tracheostomy, and that is what we do, and we can do the same for you.

In this instance, in particular, there was medical negligence. She had complications not only from bypass surgery; she also had complications from the dislodged PEG feeding tube. There’s absolutely no need to do a PEG tube in a situation like that.

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 that you can get access to if you go to intensivecarehotline.com by clicking on the membership link or 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.

You also have access to 21 e-books, 21 videos as part of the membership. Those videos and e-books are specifically designed for families in intensive care, making sure you make informed decisions, have peace of mind, control, power, and influence so that your loved one gets best care and treatment.

I also offer one-on-one consulting and advocacy for families in intensive care over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly. I represent you in family meetings with intensive care teams.

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

You can look up our testimonial section at intensivecarehotline.com and see what our clients say. You can have a look at our podcast section where we’ve done some client interviews. It is no exaggeration whatsoever when I say we have saved many, many lives in the course of our consulting and advocacy and we can do the same for you.

We also offer medical record reviews in real time so that you can get a second opinion in real time. We also offer 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, and share the video with your friends and families.

I also do a weekly YouTube live. Subscribe to my email newsletter at intensivecarehotline.com and you get notified for the weekly YouTube live as well.

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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