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

So, today’s tip is again, “Why you should not give consent for a PEG tube in intensive care simultaneously when you give consent to a tracheostomy?” Now, I have made countless videos about this topic over and over again, but this is another video because it illustrates why you should not give consent to a PEG tube (Percutaneous Endoscopic Gastrostomy).

So, here’s the situation. We are currently working with a client in the U.S. who has the 82-year-old mother in intensive care. She has been there for about two weeks now. She had a stroke, pneumonia, ended up being intubated, and after about two weeks of prolonged ventilation and sedation, she couldn’t come off the ventilator. So, the ICU was pushing to do a tracheostomy and a PEG tube.

Now, the client actually contacted us the day before his mother was scheduled for the tracheostomy and the PEG tube. He asked me, “What should I do?” I said, “Well, probably give consent to a tracheostomy, but definitely not give consent to a PEG tube.” So, we then looked at the medical records. We spoke to the doctors and nurses directly.

It became clear that, unfortunately, tracheostomy was the right next step because she couldn’t be extubated, i.e., weaned off the ventilator with the breathing tube at that stage. So, it was at about the two-week mark. So therefore, tracheostomy was the right thing to do, but we recommended to the client not give consent to a PEG tube because they had already talked about sending her to LTAC.

Now, have a look online what the reviews of LTACs are. Have a look at our case studies about LTAC. The reviews for LTAC online are absolutely shocking. Over many years of consulting and advocacy for families in intensive care, we’ve also spoken to plenty of LTACs. They really have no idea what they’re talking about. They really have no idea what to do with a ventilated patient, and things go from bad to worse.

So therefore, it illustrates, once again, that the tracheostomy and the PEG are simply conduits for an intensive care unit in the U.S. to send patients to LTAC and that is not in the best interest of a patient.

Now, in the meantime, it’s been a few days now since this lady had a tracheostomy. She’s now breathing on CPAP (continuous positive airway pressure) and pressure support. See, she is so much closer to be getting off that ventilator.

So, by not giving consent to a PEG, you actually put the pressure back on the ICU, making sure your loved one has to get better. By giving consent to a tracheostomy and a PEG for the ICU, it’s like out of sight, out of mind, we no longer need to take responsibility for actually getting a patient better and off the ventilator by literally shoving them off to LTAC. Whereas in this situation, they have to take responsibility and ownership to get this lady off the ventilator, and that’s what they’re doing now finally.

It’s a very different approach to treatment if you’re focusing on a tracheostomy and the PEG with the focus of sending them to LTAC, which by the way is not even the better version of a nursing home. So, you’re going from ICU to a nursing home. That is madness, absolute madness.

Whereas in this case, actually, the ICU team has to take ownership to get this lady off the ventilator and move her on to a hospital ward once she’s off the ventilator and has the tracheostomy removed and then get her on to proper rehab without a ventilator and without a tracheostomy. That should be the best way forward for anybody in a situation like that.

Once again, why no PEG? Well, you don’t need to PEG. A nasogastric tube will absolutely do the job. Why is that? Well, it is because many patients in ICU that are there long-term in other countries outside of the U.S. have a nasogastric tube for weeks and months on. If they need mechanical ventilation and a tracheostomy, absolutely no need for a PEG tube.

A PEG tube also has the perception of a permanency about it. That means anyone that has a PEG, a lot of doctors and nurses think, “Oh, if someone has a PEG, they never ever eat and drink again.” What a terrible outlook. Whereas with a nasogastric tube, everybody knows in a hospital it’s a temporary thing, i.e., people will aim for people to eat and drink again.

When you look at nursing homes, probably right around the world, it’s full of people with PEG tubes. It’s a terrible thing because no one makes an effort to get these people to eat and drink again. It’s much easier to just give food or nutrition by a PEG tube.

Keep that in mind at all times, always have the bigger picture and long-term outlook for your loved one in mind. Don’t buy into the one size fits all approach, especially in the U.S. when it comes to PEG tubes.

Once again, there are the exception to rules where people need a PEG tube. For example, for someone that is not coming off a ventilator, long-term, spinal injuries, motor neurone disease, cerebral palsy, for example, spinal muscular atrophy. Yes, those are patients that need a PEG in the long run. But again, they are the exception, not the rule.

I hope that helps and illustrates once again, why not give consent to a PEG tube because LTACs in the U.S. will not take patients without a PEG tube. That should tell you everything about the skill set of an LTAC. If they can’t look after a nasogastric tube and a tracheostomy should tell you everything you need to know that they’re not skilled to look after nasogastric tube, how can they possibly look after a ventilator and the tracheostomy?

So, that is my quick tip for today.

If you have a loved one in intensive care and you need help, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

We also have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. When you click on the membership link, you can get access there or by going directly to intensivecaresupport.org. 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.

I also offer one-on-one consulting over the phone. via Skype, via email, via Zoom, via WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly. I talk to you and your families directly, of course. I ask all the questions that you haven’t even considered asking, but you must ask when you have a loved one in intensive care.

I also represent you in family meetings with intensive care teams. I will be there over the phone again or online so that you know what to expect in the family meeting, that you have clinical representation there so that intensive care teams are not going to take advantage of your lack of insights into the intensive care world. All with the goal of you making informed decisions, having peace of mind, control, power, and influence.

We also offer medical record reviews in real time if you need 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 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, share the video with your friends and families, and comment below your questions and insights or what you want to see next.

Thanks for watching.

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

Take care for now.