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Quick Tip for Families in Intensive Care: Can My Husband have His Tracheostomy Removed on Room Air & Bolus Feeds via His Nasogastric Tube? 

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

So, today’s tip is another question answered for one of our members. We have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. If you go to our membership section there, you can get access to our membership as well.

So, let’s read out one of the questions from our member from one of our members and we answer it, of course.

“Hi, Patrik and team. My husband will be discharged soon. He will be getting home health care service, respiratory, physical therapy, and OT (Occupational Therapy).” This is a member who has a husband in intensive care for many months now with the tracheostomy and this is a member in the U.S. where there’s no Intensive Care at Home available at the moment.

So, she continues on, “This hospital wanted my husband to go to an LTAC (Long Term Acute Care) or a specialty hospital where the reviews were terrible. The specialty hospital is affiliated with his current hospital. I noticed they try to refer him to the places with terrible reviews but the good places, they try to deny him.

I also spoke with a dietician today about the bolus feeding option. She doesn’t have any experience doing the bolus with a nasogastric tube only with a PEG (Percutaneous Endoscopic Gastrostomy), so she will consult with the hospital dietitian who has some experience with a nasogastric at a different location.

I see now that why they push the PEG tube, his oxygen tolerance on the tracheostomy is being tested at 21%.

What oxygen method do you think would be a good backup for a home oxygen concentrator? Please advise because that can prevent ICU readmissions. Thanks for your response.”

Here is our response.

“Thank you so much for the update.

This is the first time and the only time that I’ve heard of a nutritionist or a dietician who doesn’t know about bolus feeds through the nasogastric tube. They studied that one during their college days. This reasoning cannot be an excuse.”

Whether a patient has a nasogastric tube or a PEG tube, doesn’t make a difference whether someone can have bolus feeds or not. It really all depends on whether they can tolerate it or not. Whether the PEG feeds or nasogastric tube feeds, they all go in the same location, which is the stomach, just the entry point, is different.

“But for safety, of course, they can ask for an expert opinion about nasogastric tube bolus feeding from other experienced dieticians. Bolus feeding can be given through nasogastric tube feeds or PEG feeds.

Are they planning to take your husband home with the nasogastric tube feed? You also mentioned that they’re trying to send your husband home with the tracheostomy.”

Now, the bad news here is we strictly advised about sending patients home with a tracheostomy from ICU without having ICU nurses, 24 hours a day.

Now, as some of you know, we also operate Intensive Care at Home. With Intensive Care at Home, when you look at our website intensivecareathome.com, there’s a section called Mechanical Home Ventilation Guidelines. Those home ventilation guidelines are evidence-based and are a result of over 25 years of Intensive Care at Home nursing in Germany and over 10 years of Intensive Care at Home nursing in Australia.

In both countries, tracheostomy care at home is done with 24-hour intensive care nurses, anything less than that is risky, and patients have died if they don’t have 24-hour intensive care nursing at home with a tracheostomy. It’s an artificial airway that cannot be managed safely by anything less skilled than an intensive care nurse with a minimum of two years of critical care nursing experience.

Now, let’s carry on in our email where our member is also asking what oxygen method do you think would be good backup for home, an oxygen concentrator?

“Now, it is very good to hear that your husband is tolerating 21% oxygen, which is the equivalent to room air. How is he doing with that oxygen setting so far? Does he need backup oxygen? Can you provide more information on how long he can comfortably breathe without oxygen? Is he showing signs of continued improvement in terms of his oxygenation without any oxygen? Have they discussed the possibility of removing the tracheostomy?

It would be ideal for him to be discharged without the tracheostomy. It’s necessary as a matter of fact. If he’s medically ready and it’s, generally speaking, safer to perform the decannulation while he’s still in hospital where all the experts are around.”

Now, don’t get me wrong. We do decannulate patients at home with Intensive Care at Home. However, we have the 24-hour intensive care nurses at home plus medical cover as well.

“Otherwise, for oxygen backup at home, an oxygen concentrator can be a backup option. However, we need to involve and ask the respiratory therapist as to what is the best appropriate oxygen therapy and backup plan tailored to your husband’s specific needs upon discharge.”

As I said, we strictly advise against going home with a tracheostomy without 24-hour critical care nursing, but he might be decannulated, might have the tracheostomy removed by the time he’s going home, and then an oxygen concentrator might still be needed or an oxygen cylinder as a backup.

As you know, you can also call me anytime for any more questions.  I hope that helps with your questions for your husband. Do not go home with our 24-hour critical care nurses who have a minimum of two years of critical care nursing experience.

Quite frankly, patients have died at home because they had family members support workers, or even general registered nurses without ICU experience not being able to manage a tracheostomy emergency and patients have died. So, it’s not that we don’t want your husband to go home, but we want him to be safe.

I hope that answers your question.

Now, if you want to have your questions answered by me and my team in our membership area at intensivecarehotline.com when you go to our membership for families of critically ill patients in intensive care, click on the link here at intensivecaresupport.org and get access there. Once you are a member, we answer all of your questions in the membership area and via email, all questions intensive care related.

Now, I also offer one-on-one consulting and advocacy over the phone, via Skype, via WhatsApp, via Zoom, or whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly in intensive care or to social workers, whoever you want me to talk to. I ask all the questions that you haven’t even considered asking, but you must ask so that you can make informed decisions, get peace of mind, control, power, and influence whilst your loved one is in intensive care. I also represent you in family meetings with intensive care teams and I would not go into a family meeting without having an advocate on your side.

We also offer medical record reviews in real time so that you can have a second opinion in real time. Please contact us for that as well. We 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 what you want to see next or what questions and insights you have from this video.

Thanks 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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