Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we INSTANTLY improve the lives of Families of critically ill Patients in Intensive Care, so that you can have PEACE OF MIND, real power, real control and so that you can influence decision making FAST, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from one of our readers and the question last week was
You can check out last week’s question here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer another question from one of our readers and this week Ellie, who has been featured with some of her previous questions here, Ellie PART 1, PART 2 and PART 3 about
Since Ellie’s mother is progressing and on her way to recovery, Ellie’s next question focuses on the removal of her mother’s Tracheostomy!
feeling a bit stuck again!
They keep putting off the removal of the tracheostomy and I feel she is becoming more and more delirious. Is it normal to get out if delirium them go back into it? I’m trying to stimulate her and her long term memory is fine but she talks such gibberish and when u ask her to repeat it she says I don’t know what I said .
The reason they’re not taking the tracheostomy out is they say her cough is not strong enough but she is coughing up phlegm fine herself .
The last doctor who finished on last Saturday said she was definitely ready . Then he didn’t take it out abc the new doctor (they change each week- 7 days) hasn’t taken it out and is very elusive and I can’t get to speak with him.
I’m so desperate for her to get into a more normal routine – eating and drinking .
Rehab wise it’s going ok , out most days for 1 hour . I know she needs to do longer, hoping it will get easier to do longer like you mentioned over the next week . Legs and arms seem stronger when pushing against me . The Physio girls wheeled her outside to see her grandson which was great but only did 10 mins as they were worried something could go wrong . She was ok but not holding head up as well as normal by bed.
Any ideas on how to get them to remove tracheostomy this week will be appreciated. I want to really push somehow .
I have one other question if you don’t mind!
My mum is really sleepy all the time. One of the nurses said thats a good thing. Do you think thats good and is it normal? I try to do extra exercises with her like Ive been shown by the physio but again, she was more awake and alert in the first week and now seems to be getting more tired. They are also giving her sleeping pills now and again (5 times so far) called Zopiclone (or something like that). I Will check your website now for articles!
I’m sorry to hear that things are not progressing as quick as you wish them to move!
I have just looked through my emails and you first emailed me on the 15th June and by then your mother was in ICU for three weeks, so I assume first ICU admission was around 20 -25 th May.
Therefore, your mother has now reached the two month mark in Intensive Care!
That’s a very long time by any account and I can totally see why you and your mother are getting frustrated!
After your last email I would have assumed that by now the Tracheostomy would be out!
Let’s quickly establish the facts:
- Your mother has been off the ventilator for at least a week
- She has been having the speaking valve regularly and is able to speak
- She is able to cough up her phlegm
- She has had one failed attempt to remove the Tracheostomy around two weeks ago
- They are sitting your mother out of bed around one hour per day
- The Intensive Care team claims her cough isn’t strong enough
- You didn’t mention that your mother needs regular suction(if she does, that might stop the Tracheostomy removal)
- Your mother is becoming more delirious
- Your mother is more sleepy
- They are giving her more sleeping pills
- The doctors are unavailable to talk to you
As I have outlined in a previous email, please be clear to the Intensive Care team about those guidelines for Tracheostomy removal
2) ABG’s> which stands for arterial blood gas> it’s basically a blood test that’s showing how well she’s breathing with her oxygen and carbon dioxide levels being checked
3) Speech pathology test> mainly for neurological Patients after stroke and other brain injuries to make sure Patients can swallow properly so that they don’t aspirate(= getting stomach content into the lungs) and in your mother’s case it might be advisable to test speech and swallowing function as well before Tracheostomy removal as she had it for a long time
4) also, before removal of the Tracheostomy your mother should be at least off the ventilator for a good 3-4 days
Ok, here are a number of other things that I think come into the overall situation
1) One hour per day sitting out of bed is not enough! Even though your mother has been in ICU for more than two months now and is very weak, there is absolutely no reason why she can’t be out of bed for longer than one hour per day! If she gets tired quickly, she can sleep in the chair, but sitting up is just SO IMPORTANT for your mother’s chest!
2) Your mother should not be delirious at all. All the heavy sedatives she had a few weeks back should have worn off by now and she should be wide awake. Having said that long term Intensive Care Patients often have a disturbed day and night rhythm and that may be part of the delirium. And it could well be that your mother is getting sleeping tablets because she may not be sleeping at night. The side effects can be that she will then be tired during the day and gets delirious.
What I think needs to happen from what you describe though is that your mother needs to get into a regular day and night routine so that she is awake during the day and therefore can sleep at night.
I can’t stress this enough Ellie that one hour sitting out of bed is just RIDICOULOUS!
Your mother needs to get out of bed by 9 am at the latest, have a few hours rest at lunchtime and then get out of bed again in the afternoon!
Ellie before is started doing this, I was a Nurse Manager in Intensive Care for 5 years and I can tell you that if a long-term Patient had been out of bed for one hour per day I would have asked my staff what else they were doing with this Patient. Are the staff sitting around all day or what?
Your mother won’t get strong in bed and her breathing and coughing muscles won’t get strong when lying in bed all day!
By your mother having daily and regular stimuli she will be tired at night and sleep and they need to start doing that ASAP!
Unless there is any particular reason that your mother can’t get out of bed because of a weak heart(something you never mentioned) it’s just a matter of doing it and sticking to it!
The other dilemma with long term ICU Patients often is that the Intensive Care team gets frustrated as well and they are therefore not giving your mother the attention she really needs.
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What’s also extremely important is that your mother gets good nursing care.
That is nothing less than
- Having regular washes and showers, hair washes(there is absolutely no reason your mother can’t have a shower in ICU at least twice a week! Regular showers are doing wonders for ICU Patients!
- Having good and regular mouthcare!
- Having regular and experienced nursing staff looking after her. Often the more experienced staff look after more acute and short term Patients, rather than long-term Patients
- Don’t put up with your mother having junior and inexperienced staff looking after her
- Don’t put up with a different nurse everyday, your mother needs consistency
- Urgently demand a meeting with the ICU consultant and get the facts. By now you know that they are changing every 7 days, so try and grab them early in the week and demand answers!
- Check out this article here and start becoming ”difficult and demanding”
To sum things up from what I can see, your mother needs to get more active during the day and sleep at night.
There should be no delirium whatsoever. I would strongly argue that reducing sleeping pills and stuff and getting more active is the answer to getting the Tracheostomy removed, everything else is BS.
What are the nursing staff doing all day if she can’t get mobilised? Are they the ones taking the sleeping pills? How will your mother get back on her feet again if they are not putting in the effort?
Also ask them whether they’ve given her some Haloperidol(Serenace). It’s a terrible drug and often given for delirium and from my experience it can make things worse!
Again, you have come a long way and your mother will be getting there and now you need to stay strong for the rest of the Intensive Care journey!
I hope that helps Ellie.
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In your FREE report you’ll also discover
- How to ask the doctors and the nurses the right questions
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- 5 “killer” tips& strategies helping you to get on the right path to PEACE OF MIND, control, power and influence in your situation
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- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
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- How you need to manage doctors and nurses in Intensive Care(it’s not what you think)
Thank you for tuning into this week’s “YOUR QUESTIONS ANSWERED” and I’ll see you again in another update next week! Make sure you also check out our BLOG section for more tips and strategies or send me an email to [email protected] with your questions!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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