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

So, today I have an email from one of our members that we worked with recently and here is what the member said,

“Hi Patrik,

My dad is stable for the moment, back in the ICU again. Two days ago, we got a call in the middle of the night that he needed emergency surgery. It seems they had attached the wrong end of the colon to the colostomy. They said this was due to my father’s sigmoid colon being enlarged and, in the place where the transverse colon usually is. It turns out that it was actually the sigmoid colon that was originally punctured by the original PEG tube. 

He was taken off the high dosage of blood thinner (Lovenox) that he was on, infused with fresh frozen platelets, and operated on about 8 hours later (March 22).

Less than 22 hours later, the internist put in an order that my father return to the LTAC. However, the current hospital notified us of this, and we and the RN notified the GI surgeon. The GI (Gastrointestinal) surgeon says no – my father is not ready to leave the hospital yet. 

So, the doctor said he’s not well enough for subacute care/too many issues. When he’s discharged, it will be to LTAC.

Diagnosis: Sepsis

Infections: His white cell count is normal (10). He got Candida aureus, Pseudomonas, MRSA (methicillin-resistant Staphylococcus aureus), VRE (Vancomycin-resistant enterococci), achromobacter xylosoxidans

Antibiotics: Metronidazole 500mg, Daptomycin powder, Levofloxacin

Since no new infection was found during the last surgery, antibiotics will end when previously scheduled to in about 6 days.

He’s got a bone infection on his right heel, and he’s got the partial amputation performed, antibiotic beads injected, wound vac.

GI: Colon anatomy abnormalities due to constipation, lack of motility possibly related to being long-term type 1 diabetic. 

Surgery: Bowel bisection, insertion of new PEG-tube into stomach only

Well, PEG tube (Percutaneous Endoscopic Gastrostomy) should only ever go into the stomach. There should be no other place for a PEG tube.

Colostomy, corrected colostomy 

Medications: Metoclopramide given every 8 hours, Pepcid every 8 hours, Zofran – as needed 

Nutrition: TPN (with new G-tube had tolerated tube feeding. It was stopped because of wrong end of colon brought up to colostomy) 

TPN has insulin added to it, that seemed to cause his low blood sugars yesterday afternoon and at night. The nurse has asked them to adjust the TPN. 

They said they were giving the colon a rest. I will ask when they will start trialing tube feeds.

Wound vac for incision wound 

Bed sores on bottom 

Wound care, specialty mattress, turn every 2 hours.

Not just for any of you who are wondering what TPN is, TPN stands for total parenteral nutrition. It also means intravenous nutrition. Whenever someone can’t be fed through the mouth or enterally with a nasogastric tube or a PEG tube, that’s when TPN is used. Just go to our website and type into the search for TPN and you will get more information about that. Our website is intensivecarehotline.com.

Next, UEDVT (upper extremity deep vein thrombosis): right arm in proximal right brachial vein

Today: re-started Lovenox at low dose, plan is to keep increasing

Fluid retention: medications: Lasix

Foley catheter

In the United States, at the time, continues the member:

In our county, it is only one private, for profit company that does LTACH, although there are different locations.

 I strongly disagree that there’s plenty of companies in the US that do LTAC, but I’ll talk about that later.

At the previous LTACH, they let his foot wound become infected, they let him aspirate and get pneumonia, need to go on a ventilator, and perforated his colon, and let him get septic before calling 911 and dumping him at the emergency department. We want to take him home, but the doctor says training to help with the trach and vent will take too long. We are trying to find options for skilled nursing care at home. It seems like this is a common practice for children who have tracheostomy and ventilator, but not adults in Southern California, United States.

Go and check out intensivecareathome.com for home care in the United States for your dad’s situation.  Go and check out intensivecareathome.com.

Next, the member continues.

Previous to the latest operation, he was back on the T-bar or T-piece during the day, and they were going to order a speaking valve (LTAC did not send with him or give to us when they tried to get his things).  They have done a blood gas daily and have said it’s “very good.” 

Today, he was on CPAP (continuous positive airway pressure), then the T-piece or trach mask, tolerating both well. The blood gas was done, results good, also monitor showing between 97 to 100% SPO2 oxygen levels (with 28% oxygen). Their plan is to get him back to the T-piece all day/ventilation at night, because that’s how he was when he entered this hospital. However, before the latest surgery, he seemed like he would be able to go longer because his heart rate was staying stable and oxygenation at 100, and he was not fatigued. As he heals, my plan is to ask for more time off if he tolerates it.

Sedation: He’s not sedated as such, but the two things he has available for pain as needed are IV Tylenol and morphine (it was Dilaudid, but he does not do well on that – hallucinations, stress, paranoia, doesn’t recognize family, which leads to sweating, increased heart rate)

Next, mentally, my father is alert and responsive, and able to follow directions, and signal to get his needs met. He can move his upper extremities and is working on uncurling his fingers. Last week, he was weak but able to swing his legs and sit at the edge of the bed for a while with the OT (Occupational Therapy). Today, he was worried because he can’t move his legs. It has to do with the device on his lower legs to help with circulation, the nurse thinks. 

Regarding breathing and coughing exercises, where do you suggest I look up information about that?

We have been asking for months about passive range of motions exercises for his legs. We were told he had to be clear for that and after he was, they only came once. Can you suggest a source for me to look at? 

This hospital is another one that is refusing to give any information at all until release. We had an agreement that they would print out results of procedures but that only happened one time. I have asked repeatedly, and they say they are not allowed to. This severely curtails our ability to make informed decisions about care for my father.

Mentally, my father is alert and responsive. He’s using some printed core boards to communicate along with gestures and spelling things out on one with alphabet and numbers.

Thank you so much for all you do. 

– Heather.”

Now, Heather, I know this is really, really bad situation, but it just illustrates once again, your dad was in LTAC and then he bounced back to ICU. I’ve been advising against not doing a PEG tube for over a decade here now at intensivecarehotline.com and yet your dad gets a PEG tube, and he has got a perforated bowel.

For anyone watching this, if people tell you that it needs to be a PEG instead of a nasogastric tube, well, once again, a PEG tube require surgery, nasogastric tube doesn’t require surgery. It just requires good nursing care. Anyone who’s trying to tell you or trying to persuade you that a PEG is the only way forward if your loved one can’t be weaned off the ventilator and/or tracheostomy, they’re lying to you. They’re absolutely lying to you. I will show you a research paper that I put below this video where it clearly highlights, it’s evidence-based that the PEG causes more harm than a nasogastric tube. I’m not making this up. This is just cold hard evidence, not more than that.

So, what else? Your dad is in a big, big mess really, that’s the reality. Your dad is in a big, big mess because of the things that went wrong. At least now he’s able to make some form of progress.

Now, let’s just be very clear. I have not seen patients coming off the ventilator successfully without physical therapy, without mobilization, without a lot of TLC (tender loving care), without good nursing getting your dad into having a shower, but even that your dad is having pressure sores, he hasn’t been receiving good nursing care, and that’s probably happened in the LTAC.

So, to illustrate that once again, our member here consented to a PEG tube in ICU that enabled the ICU to send him to LTAC. The member didn’t know that it was dangerous and look at the mess that this patient is in now by going to LTAC. Do not give consent to a PEG tube.

The first question you need to ask when you have a loved one critically ill in intensive care, especially if they’re ventilated with a breathing tube, “Is the intensive care team doing everything beyond the shadow of a doubt to get your loved one off the ventilator and the breathing tube and avoid the tracheostomy?” That is the very first question you need to ask. I will link to a video here how to wean a critically ill patient off the ventilator and the breathing tube. 

This is knowledge you need to have when you have a loved one in intensive care so that you can make informed decisions, have peace of mind, control, power and influence when you have a loved one in intensive care so that you can influence decision making fast making sure your loved one gets best care and treatment, that’s how important this is. Look at the surgery your dad needs to have, and this time around, do not give consent to get your dad to an LTAC. You know exactly what you’re signing up for and your dad will probably bounce back into ICU in no time. 

Addressing the medical record issue, you have the right to access medical records. We never had a client that couldn’t get medical records. You just have to take responsibility. I know we’ve sent you your rights to access medical records. Just put the pressure on. We can help you also with the complaints letter, complaints email.

With your comment about that there’s only one private company in the U.S. doing LTAC, that is not accurate. There’re so many companies that provide LTACs all around the United States, not even funny. So, there’s definitely, unfortunately, there is no shortage of LTAC facilities. There is sometimes a shortage of LTAC in certain areas, that is definitely true. I have seen patients being sent to LTAC or hospitals trying to send patients to LTAC in other states which, again, is absolutely ridiculous, and it’s just borders or negligence as far as I’m concerned.

So, I hope that helps.

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

We’ve been saving many lives for our clients and members, and you can verify that on our testimonial section at intensivecarehotline.com. You can also watch our podcast at intensivecarehotline.com where we’ve with clients and you will hear what they say about the work that we’ve done for them. We’ve even done some interviews with surviving patients where ICUs wanted to withdraw treatment, and we’ve got some of those patients even on an interview here to verify that.

Just because ICU is telling you your loved one isn’t going to survive, you have to do your own research and you can’t just take everything for gospel, absolutely not.

That’s one of the reasons why we created a membership for families of critically ill patients in intensive care and you can become a member if you go to intensivecarehotline.com if you click on the membership link or if 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. In the membership, you also have exclusive access to the 21 eBooks and 21 videos that I have personally written and recorded for our members. Those eBooks and videos will help you to make informed decisions, have peace of mind, control, power, and influence so that you can influence decision-making fast and so that your loved one gets best care and treatment.

I also do one-on-one consulting and advocacy over the phone, Zoom Skype, WhatsApp, 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 also talk to doctors and nurses directly. I ask all the questions that you haven’t even considered asking. With all my 25 years of critical care nursing experience, I can extract the information that you didn’t even know existed.

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 at one of the numbers on the top of our website or 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 from this video, and share the video with your friends and families.

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Thank you for watching.

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

Take care for now.