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Quick Tip for Families in Intensive Care: My Husband’s Back in ICU with Tracheostomy After Being Home, Does He Need ICU Nurses to Go Back Home?

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

So, today’s tip is about one of our members. We have a membership for families of critically ill patients in intensive care where we answer our members’ questions when they have family members in intensive care. So, if you want to become a member of our membership, 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 a membership area and via email and we answer all questions, intensive care related.

So, let’s dive right into the question from one of our members who says,

“Hi Patrik and Team,

My husband tried the bolus feed method today. Prior to that, he had a bit of diarrhea. The night nurse deliberately allowed a lot of air to go into the nasogastric tube and didn’t use warm water to flush it. The dietitian was trying to discourage me from doing the bolus feeds and printed a long list of disadvantages. I think they deliberately planned this to happen.

His oxygen level went down rapidly, although it came back to 80% to 90% but they did his ABG (Arterial Blood Gas), I think it was in the 40s. They transferred him back to ICU and he’s back on the ventilator. We’re planning on going home and they kept dragging their feet, finding excuses. If this had happened at home, I would have transferred him to a hospital I’m more comfortable with. I will seek to transfer him to a different hospital.”

Now, I need to give you some context about this email. So, this is a client who has had her husband in ICU for many months. Initially, on the ventilator with a tracheostomy, no PEG tube, only a nasogastric tube. The hospital was trying to send him to LTAC, but the client refused to get a PEG (Percutaneous Endoscopic Gastrostomy) tube. Therefore, the hospital couldn’t send him to LTAC (Long Term Acute Care) which was a good thing.

However, what happened next was quite disastrous because the hospital more or less forced him to go home with no support, with a nasogastric tube and a tracheostomy, and whilst we are advocating against the PEG tube for most patients when you’re going home, patients can’t eat or drink. They do need a PEG tube, not a nasogastric tube at home, especially without nursing support. I’ll come to that and break it down in more detail in a minute.

Going home with the nasogastric tube, especially when there’s no nursing support could be disastrous cause you need to check where the feeds are going, and you need to check the position of the nasogastric tube quite frequently. That’s the skill of a registered nurse.

Anyway, I’ve made a video earlier in the week, where another client, those two clients have different stories but the same situation where they’ve been sent home with tracheostomies, without ICU nurses, and they bounce back into ICU. No wonder at all.

The context here is some of you would know we are running a service Intensive Care at Home, and you can find more information at intensivecareathome.com. There we send intensive care nurses and critical care nurses into the home, predominantly for long-term, ventilated adults and children with tracheostomies, but also for adults and children that are not ventilated but have a tracheostomy . We also send intensive care nurses and critical care nurses in the home for clients on CPAP, BIPAP and they don’t have a tracheostomy, or we provide Home TPN which is IV nutrition. It can all be done at home, which has to be safe.

In those two situations, both clients bounce back into ICU very, very quickly. It’s no surprise because if someone is on a ventilator with a tracheostomy, or with the tracheostomy without ventilator, they need critical care nurses, 24 hours a day. That is evidence-based in the Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

Currently, with Intensive Care at Home, we are operating all around Australia in all major capital cities and all around the country, rural and regional as well. But even if you are watching this and you’re in the U.S. or in the U.K., please reach out to us. We can help you one way or another. We can point you in the right direction, what you should be doing with home care.

Let’s answer our member’s question about the issues with the feeds and the issues about going back to ICU. There was a follow-on email from our client which I actually didn’t see in my email thread here.

“The nurse was the one administering the tube feeds. They were the ones that stated since I will be taking him home, I should learn. I never took it upon myself to do this. I think it was just a stalling method because we were ready to go home.

His wounds are at stage 4, and I requested to go to a different hospital or center. They refused because they don’t want anyone to see their negligence on their watch. They keep telling me we are getting things in place for you to go home. I told the doctor; the case managers must be incompetent for taking so long to finalize arrangements.”

Then she continues, “I never administered the bolus feeds, the nurse did. They were insisting that I learned how to administer his medication via the nasogastric tube since I was taking him home and learned how to change his wounds. Then, I realized I shouldn’t be doing this.

I said I was going to speak to someone in administration about this and later the incident happened, and they sent him back to ICU. That’s why I think it was planned. Hospital staff are something else wicked to cover their tracks.”

Well, here’s our response.

“Thank you so much for keeping us posted about your husband’s situation.

It’s good to know that it is the nurse who gave the tube feeding. Therefore, the aspirations were not because of your attempt to feed. You can observe the nurse how they give the tube feeds to your husband, and you have the right to ask and clear some doubts. That will help you learn more about the feeding tube and by the time your husband is discharged to your home, you can participate and can help and contribute to your husband’s daily care.”

However, he will need a PEG tube. He can’t go home with the nasogastric tube unless you have 24-hour intensive care nurses, that’s when you can take him home with a nasogastric tube.

With Intensive Care at Home, we have looked after patients at home with nasogastric tubes. Nothing we can’t do at home. But you have to have the right skill because if you don’t know what to do with the nasogastric tube if you don’t know what to do with the PEG tube, if you don’t know what to do with a tracheostomy, it could be a death sentence. I’m not exaggerating here. I could give you countless of examples, but let’s not get sidetracked here today.

“It will take time for you to learn how to keep the bolus feeding safely but observing plus demonstrations will facilitate your learning process, especially if you have an interest in knowing the things. Trying to give your husband feeding with the supervision of the nurse will be of great help to you. It will help you better if you learn bolus feeding before your husband goes home from the hospital, so you can participate and provide good care to your husband, including bolus feeding when he’s discharged home.”

But once again, strictly advising you should not go home without intensive care nurses, 24 hours a day. Keep in mind, that the hospital is paying for an intensive care bed at the moment. They would be interested in cutting half of the cost of that, which is roughly how much Intensive Care at Home costs. The health insurance will have an interest in using Intensive Care at Home because we’re cutting half of the cost of an intensive care bed.

Now, let’s carry on an email, “With your husband’s pressure sore stage 4, who does the wound care? Wound care must be aseptically done daily at least. Observe the wounds, are the wounds getting worse or healing well? The wound care nurse and the doctor must assess whether the wounds are healing or need debridement or referral to a surgeon, plastic surgeon, et cetera. The dietician or nutritionist also must be involved in prescribing high-calorie, high protein feeds for your husband that will help with wound healing and repair.

Proper wound assessment by the doctors or the nurses to determine whether daily dressings with an antiseptic solution and antimicrobial treatments and ointments are needed to facilitate wound healing. While there is no schedule yet for the hospital transfer for your husband, the daily assessment of referral to the surgeon is recommended to determine if there is a need for wound debridement or what treatment is necessary to promote wound healing.

Whatever your plan is for your husband, make sure that continuity of care is observed and done to avoid the deterioration and severity of his illness. Continuity of care and ensuring his good breathing and ventilation and the staff or provider that will attend to your husband’s ventilation and tracheostomy care, who will do the suctioning of respiratory secretions, administer nebulizers, perform chest physiotherapy, tracheostomy care dressing, also inner cannula changes, nebulizers, potentially cough assist, and who will do the tube feeding because you now know if you do it, he will bounce back into ICU. It needs to be done properly. Again, that’s what we are here for with Intensive Care at Home.

Also, besides the wound care, hygiene, washing, grooming, medication administration, physical therapy, occupational therapy, speech therapy, and many others that need to be considered. Health provider who will do regular visits and assessments of your husband.

I hope this helps.”

You go and check out intensivecareathome.com. If you’re watching this and you are in Australia, we are an NDIS (National Disability Insurance Scheme) approved service provider, also TAC (Transport Accident Commission) in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland, and DVA (Department of Veteran Affairs) all around the country. We have also received funding through public hospitals, through departments of health, and now also through private health insurance. Please contact us at intensivecareathome.com.

Thank you for letting me answer this question from our member here.

Now, like I said, we have a membership for families of critically ill patients in intensive care where we answer all of your questions. You can get access when you go to intensivecarehotline.com and click on the membership link, or you’d 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.

I also offer one-on-one consulting and advocacy for families in intensive care, one-on-one over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you.

I have worked in intensive care for over 20 years where I have also worked for over five years as a nurse unit manager, and I have been advocating and consulting for families in intensive care all over the world for over 10 years now.

Now, I also represent you in family meetings with intensive care teams. I will let you know whether you should even go into a family meeting with intensive care teams because there are indicators that I have learned over the many years where you should go into family meetings and other indicators where you shouldn’t or not even on your radar. In any case, I can represent you in those meetings so that you don’t get walked all over, making sure you have clinical representation on your team so that you can make informed decisions, and have peace of mind, control, power, and influence.

When I talk to intensive care teams directly, I ask all the questions you haven’t even considered asking, but you must ask to have peace of mind control, power, and influence, and you can make informed decisions.

Now, we also offer medical record reviews in real-time so that you can have 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 simply suspecting medical negligence.

Thank you so much for watching.

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 and what questions and insights you have.

All of this 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].

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.