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Quick Tip for Families in Intensive Care: My Dad Went from LTAC (Long Term Acute Care) Back to ICU After the PEG (Percutaneous Endoscopic Gastrostomy) Tube Caused a Bowel Perforation & Sepsis! Help!

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

So today is again another email from one of our members and clients who had their father in LTAC and was trying to get him out of there when she realized that LTAC is just an absolute disaster area.

I have an email from our client here and member who writes the following,

“Hi Patrik,

A lot has happened since I last emailed. On March the 3rd at 1:00 a.m., 911 was called and my father was taken by ambulance from Kindred LTAC to the ER of a small, older community hospital in Santa Ana in California. They sent nothing with him and the nurse didn’t even know he was diabetic when we arrived the next morning. The LTAC called to inform us at 7:00 a.m.

They had diagnosed sepsis due to infection caused by recent G-tube insertion into the stomach. There were also some chest X-rays showing free air where it should not be. They hydrated him, contacted his ID doctor, and continued antibiotics.

I asked for a transfer to a higher level of care (University research hospital) but was refused to transfer because he had been transported to this place. His vitals were good, his white cell count was good, and his lungs looked good except for the bacterial pneumonia. He was already being treated for which was a pseudomonas bacteria.

The next day while being repositioned, his tracheostomy was dislodged and was unable to be put all the way back in. His oxygenation was still measuring between 99 and 100 and he was talking. The surgeon who had done the tracheostomy was called, but he was in heart surgery all day. Eventually, they called the pulmonologist and said he would perform a bronchoscopy and reintubate through the mouth, but he was able to reposition the tracheostomy correctly. The free air was gone so, it was decided that he could start back on liquid diet slowly.

Because he was already in this hospital, the foot surgery was scheduled. The MRI of his heel showed 3/4 of the heel bone infected. He was cleared for surgery and had an angiogram and angioplasty for his legs to make sure the circulation was good. Then he started vomiting.

They said it was his nerves and the feeling of the tracheostomy being uncomfortable, discontinued feeding and he was still vomiting. We pushed back that this was not his baseline, even with the tracheostomy.

We finally got another chest CT and GI (gastrointestinal), and we thought it looked like the G-tube had gone through the bowels. They did a colonoscopy to confirm, and he also had the foot surgery. It turns out the G-tube went into the colon and out of the colon ending into the stomach. He had abdominal surgery for colon bisection and colostomy the next day, Thursday, the 14th of March.

The surgeon reported that they found no leakage from the colon. One of the other doctors that came in mentioned a pus-filled sac that the GI (Gastrointestinal) surgeon was able to remove intact and that they would culture it.

On Saturday, we found out that it was pseudomonas. They changed the antibiotics to Levofloxacin so, I’m assuming the others are not working and moreover didn’t work to control the infection in the past, despite my father’s great WBC counts (white cell counts).

Pseudomonas was in the original infection/ulcer on my father’s left foot that was operated on in July 2023. We tried in the past to get the speech therapy and IV vitamins as well as probiotics, but we’re constantly shut down.

This place also has a policy of not giving any medical records, online charts, et cetera until 10 to 15 days after discharge. We have been staying for all of visiting hours trying to gather information.

After the ER, my dad was moved to telemetry. After the first night, one of us was allowed to stay over and sleep on a cot in his room. That was good for suctioning vomit immediately and trying to prevent vomiting.

After abdominal surgery, he is in the ICU. They refused to give my father/family representatives information about procedures results, et cetera and say, “Just ask the nurse”.

Where we are now:

1. In ICU
2. IV: Levofloxacin, TPN, glucose or dextrose is needed to control low blood sugar (check every 6 hours).
3. Trickle feeds initially through G-tube.
4. Inhaled: bronchodilator and Tobramycin.
5. Subcutaneous: insulin as needed to control high blood sugar.
6. Low dose of blood thinner to start treatment for thrombosis ID in UEDVT (upper extremity deep vein thrombosis) found in right brachial vein in right arm.
7. Ventilator off during the day and on T-piece 28% oxygen on the ventilator at night.

What questions should I be asking?

• Heather”

Your dad has gone through a lot, Heather, here. It just goes to show and confirming what I’ve been saying for many years. Do not let your loved one go to LTAC, then they bounce back into ICU and then they’re bouncing back to another ICU often. That doesn’t seem to be the case here, but it just goes to show its sheer madness to send your loved one to LTAC in the first place. It needs to be avoided at all costs because that is what’s happening here.

You have the right to access medical records. Don’t let anybody persuade you otherwise. You have the right. It’s not a privilege. ICUs are trying to make it difficult for you. I understand that, but just look up online, your rights to access medical records in the state of California and you will see that you have all the rights. You just need to keep putting the pressure on.

It would be good to find out what his Glascow Coma Scale is. It would be good to find out what his sedatives or opiates he’s on, if any. What are his vital signs, oxygen, saturation, breathing rate, temperature, blood pressure, et cetera, also, his weight.

What’s his heart rhythm like? Is it a regular heart rhythm? Is it an irregular heart rhythm? Is he on inotropes or vasopressor such as norepinephrine, Levophed, vasopressin, et cetera? What are the current ventilator settings? Are they suctioning secretions regularly? Is he coughing? Is he breathing spontaneously? What’s his last arterial blood gas like and last chest Xray like? That would be really, really important to find out as well.

Blood works. You mentioned white cell count, hemoglobin, the basic metabolic panel, electrolytes, sodium, potassium, calcium, magnesium, et cetera. Coagulation profile, APTT (activated partial thromboplastin time), PTT (partial thromboplastin time), INR (international normalized ratio). Then, have they done a brain and head CT scan? MRI scan? EEG/electroencephalograph? Again, a full list of medications would be good. Is he absorbing his feeds? Is opening bowels? Is he making spontaneous urine? So those would be all questions for you to ask, to look for.

But really another take home message here is do not go into LTAC. This is what happens. Patients are bouncing back, and it’s just wrong and it happens all the time. We’re dealing with it every week.

Also, because the infection got caused by a PEG tube insertion. There was no need to do a PEG tube in the first place. I’ve done countless of videos over the years not to do PEG tubes full stop because there’s no need for it. PEG tube requires surgery whereas a nasogastric tube doesn’t require surgery. The nasogastric tube is perfectly fine.

There’s research out there to say that PEG tubes cause more harm than good, which is another sign here from the email, that’s clearly causing some harm here and causing an ICU readmission. The bottom line is if you don’t give consent to a PEG, most LTACs can’t take your loved one with the nasogastric tube. So, do not give consent to a PEG.

So, keep getting access or keep trying to get access to the medical records. Just keep the pressure on. It’s good at least that they’re giving TPN/total parenteral nutrition. That’s a good sign that they’re trickling in feeds. Those are good signs that at least they’re doing the right things. But it should have never come to this in the first place. It should have never come to this. If you were paying attention to what I’ve been saying here for many years, this should have never happened in the first place.

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. I’ve been consulting and advocating for families in intensive care all over the world since 2013 here at intensivecarehotline.com.

We have saved many lives with our consulting and advocacy. You can verify that by going to intensivecarehotline.com and have a look at our testimonial section to see what our clients say. You can also have a look at our intensivecarehotline.com podcast where you can watch client interviews, who can verify the work that we’ve done for them.

Because we’re getting so many questions from families in intensive care, that’s why we created the 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.

You also have exclusive access to 21 e-books, 21 videos that I have personally written and recorded, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure you can influence decision making fast, making sure your loved one gets best care and treatment.

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

We also do medical record reviews in real time so that you can get a second opinion in real time. I also represent you in family meetings with intensive care teams. 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] com with your questions.

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If you want your email answered quickly, leave a donation here on the super chat button and I will read out your email and answer it in the next couple of days. I have so many emails sitting in my books, I’m not keeping up with it. If you want to leave a donation anyway, to support our work, that would be great so that we can make as many videos and content for families in intensive care all around the world.

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.