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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 just read out an excerpt from a medical record review that we are doing on a daily basis with one of our members.

So, I’ll just read out an excerpt where it says, on the 25^th of July, the patient is off the ventilator, continue tracheostomy collar, hemodialysis, A.M. chest X ray and labs, tube feeding through the nasogastric tube, will eventually need a PEG (Percutaneous Endoscopic Gastrostomy) tube, discharge planning to LTAC. Now, this is obviously a client in the U.S. because LTACs only exist in the U.S.

Now, let me carry on, then it says, 26^th of July, keep off the ventilator, tracheostomy collar, pulmonary toilet, hemodialysis, tube feeding, discharge the planning to LTAC, okay to transfer to the floor.

Then it continues, 27^th of July – continue antibiotics, tracheostomy collar and pulmonary toilet, tube feeding, hemodialysis. The patient will need PEG tube, discharge planning to nursing home or LTAC.

Now, I find that hard to swallow and I’ll tell you why. So, you heard me saying for many years now if you followed my blog, you’ve heard me say for many years, patients in the U.S. in ICU should not go to LTAC and there are very valid reasons for that.

So, first reason is, have a look at the LTACs in your area and have a look at their online reviews and see what they say. How many stars do families give those LTACs? I strongly encourage you to do that and have a look, that’s Number 1.

Number 2, through our extensive research and work we’ve done with our U.S. clients, when we talk to LTACs or do medical record reviews in LTACs, there’s basically patients in LTAC that are not looked after by critical care nurses in spite of most patients in those LTAC having a tracheostomy and a ventilator. The success rates to wean patients off the ventilator and the tracheostomy, from our extensive experience, is pretty poor. So, I would not let your loved one go to LTAC.

Coming back to this excerpt here that I just read out from some medical records, this is a client where we advocated for many weeks to keep him in ICU, get a tracheostomy done (which he had) and now, he’s been weaned off the ventilator and that’s in ICU.

Why would you change the weaning approach? So, the ICUs has done all the right things, weaned him off the ventilator, and now, the next steps need to happen, he needs to be weaned off the tracheostomy. Why would you change something that works? If something works, do more of it, not less.

Now, a critically ill patient in intensive care needs a stable team around them, not being sent to an LTAC. If anyone’s still wondering what LTAC stands for, it stands for long-term acute care hospital or facility. So, kudos to the ICU, they’ve done an amazing job to get this gentleman who’s in his early 80s, by the way, off the ventilator.

Coming back to the PEG tube, the PEG tube is completely unnecessary here and I’ll tell you why. So, he’s got a nasogastric tube, he’s tolerating his feeds. Patients can have a nasogastric tube up to six months and potentially even longer. There’s absolutely no need to do a PEG tube. A PEG tube requires surgery. It is a surgical procedure. Why would anyone in their right mind do a PEG tube if it can be prevented?

So, here is why it needs to be prevented. Number 1, a PEG tube has the perception in health care that it is permanent. Why would anyone, again, in their right mind want a feeding tube on a permanent basis? A nasogastric tube is temporarily.

Now, it is extremely sad that when people walk around in nursing homes, for example, they will find a lot of patients and residents with PEG tubes, that is a very sad state of affairs. Why would you want to do a PEG if the nasogastric tube will help your loved one to get off the ventilator, tracheostomy, remove the tracheostomy, and then also remove the nasogastric tube, no surgery needed.

But here is another important aspect of all of this. An LTAC, from my experience, doesn’t take a patient with a PEG tube. So, by you not giving consent to a PEG tube your loved one is safe not going anywhere. Now, there is the exception to the rule. Some LTACs do take patients with the nasogastric tube and don’t need a PEG tube. But most LTACs can’t look after patients with the nasogastric tube because they don’t have the skills to put a nasogastric tube back in, in case it gets blocked, it comes out, whatever the case may be, because you also need a chest X ray and so forth. So, that will tell you everything you need to know about the skill level in an LTAC to all of our friends in the U.S.

So, I hope that helps you understand. If something’s working, once again, do more of it, do not disrupt a care episode that’s working. In this situation, if it works, keep going, keep doing more of it, and wean this gentleman of the tracheostomy tube, no PEG tube needed, absolutely not. Nasogastric tube will do the job all day, every day. There’s also a research paper where it’s actually evidence-based that PEG tubes cause more issues than a nasogastric tube. I will link towards the research paper below this video. I hope that answers your questions.

Now, I have worked in critical care nursing for nearly 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. We’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. We have saved many lives here at intensivecarehotline.com and you can verify that by looking at our testimonial section or looking at our podcast section at intensivecarehotline.com where we’ve done client interviews to verify the work that we’ve done.

That’s also why we’ve created a membership for families of critically ill patients in intensive care and you can become a member if you go to intensivecarehotline.com, click on the membership link or 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 have written and recorded that will help you to make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment.

I also do one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime process and situation that you simply can’t afford to get wrong. I also talk to doctors and nurses directly on your behalf and 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.

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 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 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 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 where I answer your questions live on the show and you will get notification for the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber to my email newsletter at intensivecarehotline.com.

If you want your email questions answered quickly, leave a donation here on the super chat button and I will answer your question here on a YouTube video just for you. I’ve got so many emails sitting in my inbox from the last six months, I can barely keep up making these videos. If you want to leave a donation to support our work, we appreciate that, me and my team appreciate that very much, so that we can make as many videos for families in intensive care as possible.

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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