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

So, today I want to answer a question from one of our clients who has their 69-year-old mother in ICU with liver failure, COPD (Chronic Obstructive Pulmonary Disease), she is ventilated with the tracheostomy, she’s got bed sores, and the ICU is trying to push a PEG (Percutaneous Endoscopic Gastrostomy) tube to send her out to LTAC. Obviously, this is a US based client. We’ve been helping them for quite some time, but I just wanted to break down one of his emails so that you can see how we help our clients.

So, “Hi Patrik,

I wanted to see how my mom’s lungs are doing. When she got to be turned to the right side, her lung was filled with mucus and most recently, it shows the same thing. So, I want to see how we can improve it and what we can do to get her back on track with getting her back on the T-piece. 

On T-piece, it means she would be breathing spontaneously. T-piece also can be replaced by a tracheostomy shield or by a tracheostomy mask, which is basically when a critical ill patient is taken off the ventilator and the breathing tube.

I also wanted to check if there wasn’t any damage with her lungs or stomach due to start in putting her camera down my mother’s throat, which is a bronchoscopy, which she’s had in recent days. Because after the bronchoscopy, she had problems with her oxygen. They stopped her spontaneous breathing trials on the T-piece and put her back on the ventilator as well as the oxygen needed to go back up.

I want to see how they are maintaining her levels with her liver and to see how they can improve her bed sores that she got in the hospital due to lack of staff being proactive. It was a rash that they let go at the stage 3 pressure wound, but mostly her oxygen and blood results and overall plan to get her back on track because the ICU team wants to have a meeting soon to inform me of their plans for my mother to go to LTAC (Long Term Acute Care). 

We need a review so we can get her on a regimen that will help her get back on the tracheostomy collar or T-piece and heal her bed sores and how they can manage her liver levels. We just need a good game plan because they are more worried about manipulating her levels to try to get a PEG (Percutaneous Endoscopic Gastrostomy) tube on her to send her out to LTAC. 

How can you help?”

Well, that’s a great question. 

If her lung is being filled with mucus, even though she had a bronchoscopy in recent days, and I know it caused some bleeding, that was actually another quick tip that I had from this particular client. I’ll tell you how you can get rid of mucus when you don’t want to do a bronchoscopy. It’s not always necessary to do a bronchoscopy when there’s a lot of sputum accumulation on the chest and your mom is having difficulties breathing which is evident by her oxygen levels going higher and by her needing a lot of suctioning. 

So, one way to manage excessive sputum on the chest is with drainage. What that means is turn a patient on the side, head down and let gravity work to drain out sputum. Other things that need to be done are nebulizers to loosen up secretions, definitely humidified oxygen. But nebulizers, humidified oxygen, turning your mom on the side where the sputum needs to go up, then head down, let gravity work, drain the sputum and also suction. But also, chest physiotherapy, chest percussions, that is really, really important. Just by doing that, you can drain a lot of secretions. Been there, done that.

I’ve worked in critical care nursing 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 all around the world since 2013 here at intensivecarehotline.com. I can confidently say that we have saved many lives with our consulting and advocacy. You can verify that by looking on our testimonial section at intensivecarehotline.com or you can verify it on our intensivecarehotline.com podcast section where we’ve done some client interviews.

So, coming back to our client email, you can also get your mom in prone position, which means head down on the tummy. That can be uncomfortable, but it is often very effective to drain secretions and mucus from the chest.

Now, you’re saying you also want to see how they are maintaining her levels with her liver. Again, it probably comes down to minimizing the medications they’re giving so the liver can have a bit of a break. But also, how much medications as well as food she’s getting. Keep that ideally to a minimum.

With the pressure sore, she needs to be turned from side to side regularly and she needs to have a wound care nurse or wound care team look at the pressure sore so that it can be managed and healed. I agree with you, if they’re not doing regular pressure area care, it’ll go from bad to worse, and that is simply negligence.

What else needs to be done in order to get her back on the spontaneous breathing trials? Once again, good physiotherapy, chest percussions, spontaneous breathing trials on CPAP (Continuous Positive Airway Pressure), get the physiotherapist, the respiratory therapist, and so the nurse talk to her through the breathing, that is really important. See her out of bed, mobilize her. I know you’ve got the concern about the pressure sores, but they should be able to work around that with a gel cushion so that the pressure sore is not getting more pressure. There are definitely ways to work around that. So, get them to mobilize her, chest sitting up, coughing exercises, breathing exercises, chest percussions, and you will see that your mom hopefully can go back on the spontaneous breathing trial on the T-piece or on the tracheostomy mask pretty quickly.

With the PEG tube, you know my standard. If your mom has a nasogastric tube, there’s absolutely no need for a PEG tube. I wouldn’t even engage the discussion. I would just brush it off and I wouldn’t worry about it at all if I was you. Because without a PEG tube, chances are she won’t go to LTAC at all because no LTAC will take her without a PEG tube. That should tell you everything you need to know about the skill level of a LTAC, that they simply don’t have the skills to manage a nasogastric tube. That should tell you in and of itself about the skill level of a LTAC. If they can’t manage a nasogastric tube, how can they possibly manage to wean a critically ill patient off the ventilator and the tracheostomy? They can’t.

So, that is my quick tip for today.

We have helped hundreds of clients over the years at intensivecarehotline.com, all families in intensive care. That’s why we created the membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com by clicking 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 21 eBooks and 21 videos that I’ve personally written and recorded, sharing all my 2.5 decades worth of ICU nursing experience with families in intensive care and with all of our valued clients so that you can make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always.

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 talk to doctors and nurses directly. I represent you in family meetings with intensive care teams. I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong. I will make sure you ask all the right questions as well. When I talk to doctor and nurses directly, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also get 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] with your questions.

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, what questions and insights you have from this video.

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Thank you so much 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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