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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 one of our clients, Jennifer, who consulted with for quite some time, and just an excerpt from one of our consultants to illustrate how we help our members and our clients. So, Jen writes in,

“Hi Patrik, 

I just got a call from the ICU doctor, and he said my husband would benefit from a PEG tube (Percutaneous Endoscopic Gastrostomy) tube and it doesn’t have to be permanent. It can be removed, and he can be fed via mouth as he can tolerate that as well. That would get the tube out of his nose, the nasogastric tube, which is probably very uncomfortable for him and it’s a way of currently feeding him.

He also wants to do a tracheostomy, which would mean that he doesn’t have to be on the ventilator anymore and that doesn’t have to be permanent either as he can be helped to breathe through his mouth/nose again.

Can you let me know if these are good ideas as the doctor has asked me to sign for consent for both procedures?”

So, it’s a very good question. It’s a question we get all the time. 

This is a client in the U.S. In the U.S., for any of you following my blog for quite some time, you would have seen that in the U.S., many patients in ICU are getting pushed towards the PEG and the tracheostomy if they can’t come off the ventilator or supposedly can’t come off the ventilator. Many of those patients could come off the ventilator if ICUs were trying harder, but they often don’t, they just want to do a PEG and a tracheostomy and they want to send patients out to LTAC (long term acute care) in the U.S.

So, it’s not a good idea to do a PEG. Definitely not because it gives the perception of a permanent feeding tube, and no one will bother trying to get these patients to eat and drink ever again. It is my experience.

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 since 2013.

We have been saving many lives with our consulting advocacy. You can verify that by going to intensivecarehotline.com, having a look at our testimonial section, click on the testimonial section or by listening to our intensivecarehotline.com podcast where we have done client interviews who verify the work we have done for them.

So, a PEG tube gives the perception of a permanent feeding tube, and no one will bother trying to get that patient to eat and drink again, which is horrific. Whereas a nasogastric tube has the perception of a temporary feeding tube, which means the goal is the tube will come out eventually. So, people will start trying to feed a patient orally again, which makes perfect sense and that’s how it should be. Therefore, do not give consent to a PEG tube.

There are exceptions to the rule if someone can’t come off the ventilator beyond the shadow of a doubt, but that’s not where Jennifer’s husband was at the time, then the PEG feeding tube, were all for it. But they are the exceptions, not the rule. Keep that in mind.

Now, there’s also a research study out there that PEG tubes are much more harmful than nasogastric tubes. I will link below this video. So, I’ll put a link to this video for the research study. It’s not my research study, it’s independent and it just shows that what is actually documented.

Next, Jennifer wants to give consent to a tracheostomy, and I know Jennifer’s case really well. Her husband needed a tracheostomy at the time there was no question about it, but there was actually no guarantee that he could come off the ventilator, and that’s often where misconceptions come in when families have loved ones critically ill in intensive care.

Just because someone needs a tracheostomy does not necessarily mean they don’t need a ventilator anymore. It depends on ventilator settings. It depends on conscious state, on neurological conditions. It depends on ventilator settings. What ventilator parameters are there? What ventilation mode, PEEP (positive end expiratory pressure), pressure support, respiratory rate, FiO2, arterial blood gases, chest X-rays, and so forth? So, this is what’s happening here. 

So, you need to get a second opinion before you give consent to a PEG or a tracheostomy. You need to be able to think ahead. What is next if you do give consent to a tracheostomy or a PEG?

Most of the time, if your loved one can’t come off the ventilator beyond the shadow of a doubt and you need to check whether it’s beyond the shadow of a doubt, a tracheostomy is the right thing to do but do not give consent to a PEG tube. Just don’t do it. 

Nasogastric tube is perfectly fine. Patients can stay with the nasogastric tube for months on end and chances of them going to LTAC, again, this is for our U.S. audience, is very slim because LTAC generally speaking, can’t look after patients with a nasogastric tube. 

So, that is my quick tip for today. I hope that helps you understand this incredibly difficult territory. 

We’ve helped hundreds of clients and members for families in intensive care that’s why we created a membership for families of critically ill patients in intensive care. 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 21 e-books and 21 videos that I have personally written and recorded sharing all my decades worth of ICU nursing experience with you making sure you make informed decisions, you have peace of mind, control, power, influence so that you can influence decision making fast so that your loved one gets best care and treatment.

Furthermore, I also do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you, and I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. Don’t walk blindly like 99.9% of families do. Make sure you get the second opinion, the advocacy that your loved one needs in the current healthcare climate all around the world. 

I also talk to doctors and nurses directly on your behalf or with you. 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. Also, I 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 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, comment below what do you want to see next, what questions and insights you have from this video.

I also do a weekly YouTube live where I answer your questions live on the show. You will get notification of the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber to our intensivecarehotline.com email newsletter at intensivecarehotline.com.

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.

Related Articles:

Quick Tip for Families in Intensive Care: When’s a Pt a Candidate for a Ventilator? What Criteria for a Pt No Longer Needing a Ventilator? Case Study: How to Save your Loved One’s Life in ICU or How to Prevent a “One Way Extubation” Quick Tip for Families in ICU: My 80-Year Old Dad’s in ICU After Heart Attack & Now ICU is Saying He’s in Multi organ Failure! Help! Quick Tip for Families in Intensive Care: How to Treat a Cardiac Arrest in Intensive Care! Quick Tip for Families in Intensive Care: Is it Safe for My Grandma to Go to LTAC After Stroke, Tracheostomy, and Nasogastric Tube?