“Can the ICU team do a tracheostomy without family consent? Knowing your rights!”

My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always, even if you’re not a doctor or a nurse in intensive care.

So, if your loved one is in intensive care and you’re feeling powerless or confused about what’s going on, stick around, because today’s topic is a big one: “Can ICU teams do a tracheostomy without family consent? What you can do if they’re planning to extubate or do a tracheostomy without your approval?” Make sure you subscribe to my YouTube channel for more real ICU insights and tips to help you make informed decisions fast, and sign up to our email newsletter here at intensivecarehotline.com as well.

So, today’s question comes from one of our clients, Angela, who writes:

“Hi Patrik,

I just found out from my mom’s nurse that they plan to extubate her and do a tracheostomy today. Can they do a tracheostomy without my permission? Can I ask them to reintubate if it fails?

Trying to talk to the critical care doctor and neurologist before they do anything. What are your thoughts? What is your advice?”

Angela, this is a very common and very important question, one I get from families almost every week. Let’s be clear, no, the ICU cannot legally perform a tracheostomy without your consent, from the next of kin or medical power of attorney, which I know you are, unless there’s an immediate life threatening emergency, which in most tracheostomy cases there isn’t.

A tracheostomy and even an extubation are both major medical decisions and procedures that can determine life or death outcomes. You need to choose the window of opportunity and the timing wisely. Therefore, you must give informed consent, meaning the doctors must explain the risks and benefits, the alternatives like staying intubated longer or trying to wean differently.

Also, other alternatives such as extubation and BIPAP (Bi-level Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) ventilation, high flow nasal cannula, and of course the potential outcomes of each choice. If your mom cannot make her own decisions, you have the right and responsibility to speak on her behalf.

Now, what really happens in ICU is, what most families don’t even know, ICUs often push for tracheostomies early because they want to free up ICU beds or transfer patients to other facilities, save money, save beds, save resources, sometimes even when the patient might recover with more time in ICU. This can be driven by bed management, financial pressures, resource pressures, such as having not enough staff.

I can tell you from my own experience, having worked in critical care nursing for over 25 years, that if an ICU doesn’t have enough staff, it is often a cultural issue. I mean, you’ve all seen workplaces where workplaces can’t keep staff, that’s never a good sign. Imagine you’re in an ICU where there’s extremely vulnerable patients and they don’t have enough staff, that’s probably telling you everything about the culture of the ICU that you need to know, it’s not a good one. A good ICU will be able to keep staff. That shows inpatient outcomes, it shows inpatient and family satisfaction. So, look at all of those signs.

Now, when the ICU team says we’re planning to extubate or do a tracheostomy today, you must pause everything and say, “I do not consent to any procedure until we’ve had a family meeting, all my questions answered with a critical care doctor and the neurologist.” This puts you back in control.

Also, very important here, the ICU team cannot extubate and then do a tracheostomy. That’s actually not how it works. This is what I mean when I’m saying the biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. That is actually what you are up against.

So, you cannot extubate, and then do a tracheostomy. What happens is if a tracheostomy is being done, a tracheostomy is being inserted while the breathing tube is being removed because mechanical ventilation is life saving and is necessary in situations like that, you need to do an exchange simultaneously so that breathing doesn’t stop. So again, just by explaining this to you, this puts you back in control.

Also, the ICU team, by telling you they want to extubate and then do a tracheostomy, they have not informed you properly about the procedure. If they extubate and then do a tracheostomy, your mother could die. You only have a couple of minutes to make sure the airway is safe and secure.

Again, I repeat myself here, but I think it’s so important that you understand. The biggest challenge for families in intensive care is that you don’t know what you don’t know. Just by your question, I can see you don’t know what you don’t know. But it’s good that you’re one of our clients because we can help you walking through this step by step.

Terminology is very important and understanding that terminology is even more important. Now, Angela also asked, “Can I ask to reintubate?” Yes, absolutely. If your mom is extubated and can’t breathe properly, and doesn’t have a tracheostomy, you can request reintubation. But before that, they should be looking at BIPAP, CPAP ventilation, which is mask or non-invasive ventilation, high flow nasal prongs, chest physiotherapy. So, you can absolutely request reintubation, but it is also important that they choose the timing of extubation wisely.

Unless there is a do not intubate (DNI) or do not resuscitate (DNR) order in place, but you haven’t mentioned any of such, you must clarify all of that upfront, make sure you really understand what’s happening. If no such order exists, the ICU has a duty of care to reintubate or do a tracheostomy if medically indicated.

If you’re in a situation like Angela’s, the ICU is trying to rush you into a decision and you don’t really understand what’s happening, you must reach out to us. Don’t go through this alone. Go to intensivecarehotline.com, call us and contact us there and we can help you step by step.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, 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 situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking 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 do medical record reviews after intensive care if in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and 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 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

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, share the video with your friends and families, and comment below what 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 for the YouTube live if you are a subscriber to my YouTube channel or my 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.

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