Hi it’s Patrik Hutzel from INTENSIVE CARE AT HOME where we provide tailor made solutions for long-term ventilated Adults & Children with Tracheostomies and where we also provide tailor made solutions for hospitals and Intensive Care Units whilst providing quality services for long-term ventilated patients and medically complex patients at home, including home TPN.
In last week’s blog, I talked about,
You can check out last week’s blog by clicking on the link below this video:
In today’s blog post, I want to answer a question from one of our clients and the question today is
Can I Take My Wife Home from Intensive Care with Ventilation, Tracheostomy and TPN? Live Stream!
Good evening, wherever you are. Welcome to another intensivecarehotline.com livestream. Welcome, and today’s livestream is about, “Can I take my wife home from ICU or Intensive Care with ventilation, tracheostomy, and TPN?” So, for those of you that don’t know what TPN is, we’ll dive into that today, TPN stands for Total Parenteral Nutrition, which is also known as IV or Intravenous Nutrition, as some patients in ICU require IV or Intravenous Nutrition, also known again as TPN (Total Parenteral Nutrition). So, that’s today’s topic.
Just some housekeeping issues, if you have any questions regarding today’s topic, just want you to type them into the chat pad or you can dial in live on the show. I’ll give the numbers out a bit later after today’s presentation, but you’re welcome to ask your questions live on the show if you would like.
So then, you may wonder what makes me qualified to talk about today’s topic? So, I am a critical care nurse. I have worked in intensive care for over 20 years, coming closer to 25 years now in three different countries. I have worked as a nurse unit manager for over five years and I am the founder and director of Intensive Care at Home, where we provide home care nursing for long-term intensive care patients by sending intensive care nurses into the home, 24 hours a day. We are predominantly operating at the moment in Australia, Melbourne, Sydney, Brisbane, Adelaide, Perth, but also in regional areas within Australia. We have flown in staff into remote or regional areas from the big metropolitan areas like Sydney or Melbourne. There’s really no corner within Australia where we can’t provide services.
I’m also the founder of intensivecarehotline.com. You will find Intensive Care Hotline is a consulting and advocacy service for families in intensive care and we have been consulting and advocating for families in intensive care all around the world since 2013. We’re coming close to 10 years, but we’re coming to 10 years next year. Same with Intensive Care at Home. We’ve been in business for coming close to 10 years, and that’s a little bit about me.
So, without further ado, let’s dive right into today’s topic, “Can I take my wife home from intensive care with ventilation, tracheostomy, and TPN?”
So, I could have phrased today’s question also, “Can I take my husband, can I take my mom, my dad, my brother, my sister”, you can use any title really there, whether someone can go home with ventilation, tracheostomy, and TPN. The short answer is, yes, you can take your loved one home from ICU, or we can help you, I should say that way. We can help you to get your loved one home with ventilation, tracheostomy, and TPN but it’s got to be done in the right fashion. It’s got to be done with the right structure, right support structure to make it safe.
To illustrate, again, the current paradigm in most ICUs is still, there’s two ways for a patient to leave intensive care alive. One way is to go to a hospital ward, hospital floor, and go onto rehabilitation from there. The second option is for someone to die. That’s a very, very limited mindset. And obviously at Intensive Care at Home, we have created a third option, which is to go home from intensive care directly with 24-hour intensive care nursing. So, we have already changed the paradigms in ICU, or I should probably say we have already changed what were very outdated paradigms in ICU, because we’ve created a third option.
So, why can we do ventilation, tracheostomy, and TPN at home? Well, the short version of it is, because we can, but now the version is really because we have the expertise. We have third party accreditation, we have the know-how within our organization to make that happen just as much as hospital ventilation, tracheostomy, and TPN can only really be done in ICU, we can elevate that to a home care environment. We are the only organization in Australia, potentially even worldwide, that has achieved third party accreditation to provide Intensive Care at Home services.
So, we have built the intellectual property, we have built the policies and procedures, we do have the workforce that can make this happen and pull it off. Here in Australia in particular, our services are funded by the NDIS, the National Disability Insurance Scheme. And if you are a participant and you don’t have enough funding, you should reach out to us as a matter of urgency. And if your NDIS support coordinator is telling you there is not enough funding, you should reach out to us as a matter of urgency. We wouldn’t be in business if there wasn’t enough funding. Your NDIS support coordinator probably doesn’t have a clue what to do, because most NDIS support coordinators are not health professionals, and they have no idea what to advocate for and that’s where we can help you with.
If anything, we are helping the NDIS support coordinators with the advocacy, because they come to us and ask us, “What needs to happen in terms of advocacy?” And if you are an NDIS support coordinator watching this, again, you should reach out to us. We can walk you through it step-by-step. As ICU nurses, we know what needs to be verified by the NDIS to get funding for Intensive Care at Home, but there’s also other funding bodies that fund our service, like the TAC in Victoria, which is the Transport and Accident Commission, like iCare in New South Wales, like the DVA, the Department of Veteran Affairs and so forth.
So, we are employing hundreds of years of ICU nursing experience in the community. And again, with that amount of clinical know-how, and with the amount of staff that have now come from an intensive care hospital background, coming to us and using their skills in a different environment, it’s just elevating intensive care into a whole different level.
Now, next, we also, as some of you would be aware watching this, we are also providing obviously, services to clients, ventilated adults and children with tracheostomy at home. And we are also providing “only the home TPN”. So, we can certainly combine both. We had clients at home that were not ventilated, didn’t have a tracheostomy, but needed home TPN. There’s no reason for us not to combine ventilation, tracheostomy, and TPN if that’s what’s required for a particular client.
And again, how do we make it safe? So, when you look at our website at intensivecareathome.com, you will find a section there, the Mechanical Home Ventilation Guidelines and the mechanical home ventilation guidelines clearly say that you can only provide ventilation, tracheostomy care at home with intensive care nurses with the minimum of 2 years ICU experience. So, those mechanical home ventilation guidelines are evidence-based, come from decades of research, predominantly from Germany, Austria, and Switzerland, but also now Australia, where and especially Intensive Care at Home services in German-speaking countries have been around since the late 1990s. And obviously we now have taken that concept and implemented it here in Australia very successfully. And hopefully, we can roll it out next to the U.S. and to the U.K. next. But we’re not in the U.S. and in the U.K. yet. But we are helping families by educating them about the possibilities. We’re helping hospitals by educating them about the possibilities to take someone home. But very few organizations, if at all, can pull it off. Again, a lot of intellectual property needs to be built to pull it off.
Next, let’s just quickly look at the TPN in particular. I mean, I’ve talked about ventilation tracheostomy at home at length on my YouTube live streams here, but also in my quick tip videos. Let’s just quickly talk about the TPN aspect. What needs to happen for the TPN aspect? So, the first thing that needs to happen is a patient needing TPN needs a central line, a PICC line, a Hickman’s line, or a midline in order to safely administer the TPN.
What is TPN again? TPN is a bag of intravenous nutrition, comes with all the nutrients. Indications for TPN are often things like gastroparesis, digestive issues so that oral intake or food intake through a PEG tube or a nasogastric tube is no longer possible and that’s when TPN kicks in. That also should answer your question, if we can do ventilation, tracheostomy, and intravenous fluids, yes, we can do all of that. Intravenous fluids are actually much easier than TPN. I hope that answers that question. There’s also often a combination that if someone is on TPN at home, that they also require IV or intravenous fluids as well.
So, what else is needed for our TPN? Again, the TPN bag and you can often get that, you need a prescription from the doctor. The TPN is often manufactured by companies like Baxter or Fresenius, not endorsing any of them. They’re both pretty good, just mentioning them that, that’s where the TPN can be sourced from. You need to check electrolytes quite regularly, like potassium, magnesium, calcium, et cetera. There could be some add-ons for the TPN. Again, this is going to be up to gastroenterology to see whether the TPN needs to have any add-ons with the PICC (peripherally inserted central catheter) line, central line, Hickman’s line, or midline. That is also the skill of an intensive care nurse to access those lines, flush those lines, aspirate those lines, hep-lock them, making sure they’re not blocking, making sure they’re patent, making sure the dressing’s changed once a week, and so forth. Those lines can often stay up to three, six months, sometimes even 12 months. But again, that is part of our skill to manage that.
And if you have a loved one in intensive care needing ventilation, tracheostomy, and TPN and you can’t get them home, because this is the first time you’re hearing about it, that it’s a possibility, you should contact us as a matter of urgency. And again, if you are an NDIS support coordinator or any care coordinator from another funding body, you should contact us as well. Because we can help you with setting it up, of course, deliver the service, walk you through it step-by-step. And it’s a step-by-step process, as much as we all would like to have a quick fix, preparing for Intensive Care at Home takes a little bit of time. If all the equipment is there, we can pull it off reasonably quickly, sometimes within a few days, depending on the location, depending on client’s preferences and so forth. But it’s doable, and we’ve done it, and we would love to help you and your family as well getting home on TPN.
What else is needed? An infusion pump is needed so that the TPN can be infused at a certain quantity per hour, often mls per hour. Just preempting a question here, “Can we do this for adults and for children?” Absolutely. We have done both ventilation, tracheostomy, and TPN for both adults and children. Again, it’s part of our repertoire, it’s part of our area of expertise, and whether it’s adults or pediatrics, doesn’t really matter. We have both adult ICU nursing staff and pediatric ICU nursing staff, and most of our adult and pediatric ICU nursing staff can work with adults and vice versa with pediatrics. So, we have a great team of ICU nurses and shout out to the team if you are watching this, shout out to our ICU nurses on the road. You’re doing an amazing job. But also shout out to our amazing admin team, coordinating it all, 24 hours a day, with the rosters and so forth. So, we have an amazing team working here and just shout out to everyone.
So, I understand that if you have a family member in ICU needing ventilation, tracheostomy, and TPN, it sounds overwhelming, I completely understand that. But we can help you with breaking the overwhelming situation down and we can help you by breaking it down into manageable steps, whether that’s from educating the ICU about our service, from organizing the funding, from assessing your home for the suitability. But we’d be surprised, most homes are easy to access. Most homes, we can provide services at home. There’s no issue really. So, we can help you with funding, we can help you with staff selection, obviously, we can help you with the equipment. No big deal. We’ve done it so many times that it’s a smooth process. We have a checklist of things we are going through, what needs to be set up when someone is going home on a ventilator with the tracheostomy and TPN so that it’s safe, so that we are achieving our KPIs (Key Performance Indicator), which is no readmissions back to ICU and also having all shifts filled of course. So, that is really important.
Now, you might also wonder, what’s the doctor cover in situations like that? The doctor cover really comes back to, could be your, sometimes it comes from ICU directly, sometimes it comes from a respiratory physician, especially around ventilation, tracheostomy with a TPN, it can come from gastroenterology with the combination of ventilation, tracheostomy, and TPN. There probably need to be two teams involved. Again, one would be respiratory, and one would be gastroenterology. But again, no big deal. We’ll deal with two teams. You can deal with two teams after hours. We make use of afterhours doctor services. They’re available, 24 hours a day. So, we are finding ways of having doctor cover, 24 hours a day.
Also, we have now started or partnered with an organization that is offering home x-rays. How amazing is that? So, one organization that we are now working with in Australia is providing home x-rays. That is fantastic. So, no longer do our clients need to go to an emergency department, have chest x-rays done, they can be done at home now. Again, it’s all about win-win situations, all about win-win.
So then, it’s much more straightforward than you think it is, going home on a ventilator with the tracheostomy, with TPN. Also, funding for services is much more straightforward than this with the NDIS now or other private health insurances funding. If you have private health insurance, again, you should talk to us one way or another. You should talk to your private health fund. But it probably helps if you talk to us first, because we can present it. We believe much better clinically to a health fund as well, similar with the NDIS or any other funding bodies like TAC, iCare, DVA. Again, we wouldn’t be in business if we didn’t know how to present things in a certain clinical light so that funding is going to follow from a funding body.
I think that is pretty much what I would like to add there for today when it comes to, “Can I take my wife home from ICU or intensive care with ventilation, tracheostomy, and TPN?” It’s very straightforward. We can help you. We can do it. We’ve pulled it off many times and you should contact us. That’s all I can say there.
I want to open up the floor for some questions. If you have any questions, type them into the chat pad or if you want to dial in live on the show, you can call now. If you’re in Australia, you can call on 041-094-2230. That is 041-094-2230. If you’re in the U.S., please contact us on 415-915-0090. That is again 415-915-0090. And if you’re in the U.K., you can contact us on 0118-324-3018. That’s again U.K.0118-324-3018.
Now, while I’m waiting for questions to come through, I’ll just read out some other questions that we get quite frequently and answer them. Yes. One question that we get quite frequently when it comes to home ventilation, tracheostomy, “How do you select for the right staff? Will there be a high staff turnover? And how do you select for the right staff?” Well, especially when we first start with the 24-hour roster that to get things going, we probably give you a wide variety of staff to choose from. So, we can get the program going and then we adjust as we go along. Some staff you would like, some staff, maybe not so much. It all comes down to selecting the right staff for the right clients. And again, we are helping you with that. But it might take a few weeks, sometimes even, few weeks until we have a stable team for you. Okay, so be patient. Okay.
Mama Tried’s got a question, “Hi. I have a beloved friend in a COVID Recovery Hospital. His family wants to bring him home. He’s been in a hospital now since November 26th of last year, he’s on all the things you mentioned. Will you be branching out to the U.S. in the near future? And do you recommend any company in the U.S.?” Thanks Mama Tried for your question. So, your friend has been in the hospital for about a year. Wow, that’s shocking. Okay. Are we branching out to the U.S.? Yes, we are, but again, not there yet. We’re not there yet. Can we recommend any company in the U.S.? There is a company called Bayada, B-A-Y-A-D-A.com. You could contact them. I know they have done similar work to what we are doing in Pennsylvania. They are all over the country, Bayada. So, I’m not sure whether they do it in other areas too. But it’s best for you to contact Bayada.
Can I ask you this, Mama Tried, where is your friend? Which state or which state are you in? That’s probably the next question to work out. Where are you? Because we do have maybe someone else in New York and maybe someone in Virginia. So, if you can share with me where the location is, Mama Tried, then I should be able to help you as a next step.
Okay, so in Charlotte, North Carolina. Okay. Don’t know anyone in Charlotte, Mama Tried, or in North Carolina for that matter. I think your best bet for now is reach out to Bayada at bayada.com.
Now, let’s just get to a few questions that we get quite frequently, so that I give everyone a little bit more time to ask questions while I’m answering other questions that we get so often. I’ve got a whole list of questions that we get. Another question that we get quite frequently is, “If my loved one is on a ventilator for 10 months or for longer, with the tracheostomy and on dialysis, can you go home or can you help us take my loved one home as well?” Absolutely. Ventilation, tracheostomy, dialysis, TPN, bread and butter for us. So, no matter what it is in terms of clinical complexities, we can really pull it off.
Here is another question that I have from a reader, from Jack. He says, “Your information and insights have been very interesting. I’m looking for additional information. Maybe you have it. Maybe you can direct me to a source. My wife has been comatosed for a month after a serious accident. She’s now in an intermediate level care facility and the plan is to move her to a less intense, subacute facility. She has a tracheostomy in place but is breathing on her own. I have the opportunity to visit several facilities this week and ultimately pick one. I’m looking for a list of suggested questions to ask at each facility. If you have such a list or can point me to a list, I would be very appreciative. Thanks, from Jack in the U.S.” Jack, so my recommendation is that no matter where she goes next, she needs ICU nurses, 24 hours a day. That comes back to what I mentioned before with the mechanical home ventilation guidelines. If you have intensive care nurses at home, 24 hours a day, you should not water that down anywhere else. So, that’s what you should be asking for. What’s their skill level? What is their skill set? What’s their success rates? Can you talk to other families that have loved ones there? Is she getting mobilized? What are they doing to get rid of that tracheostomy? How much more time do they need to get rid of that tracheostomy? What are their action steps? What makes them positive that they can get rid of the tracheostomy?
Next. The best way, because you’re in the U.S., but if you were here in Australia, I would say, well, let’s talk and we’ll take her home. Especially if she had a car accident, there should be insurance. If she was here in Victoria, probably would be the TAC (Transport Accident Commission) that would be paying for it. Or if you were in New South Wales, it would be iCare paying for it and we could then definitely take her home without any issues. But it’s good that you’re asking those questions. But I’m telling you that we had clients at home, not on a ventilator, but just with the tracheostomy and we were only funded for night shifts by the NDIS. And despite our warnings, the clients passed away, clients, and I’m talking plural here, passed away during the daytime, because there were no intensive care nurses present that could manage a medical emergency. So, you got to be very mindful of that. You’re not bordering your skills down. Very important that your skills are up to date at home, and we can help you with that, with Intensive Care at Home, for example.
So, your goal should be to get her off that tracheostomy as quickly as possible and then take her home. Then, going home will be so much easier. But here in Australia, we could help you with that going home. Okay,
So then, Mama Tried says, “Thank you for that info, Bayada information.” Of course, you’re welcome. You’re very welcome.
Okay, maybe we can wrap this up for today. If there are no other questions, I really appreciate you coming onto the show. I really appreciate you asking the questions.
Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, and we answer all questions intensive care related.
If you want a medical record review, contact us as well. We can help you with a medical record review for your loved one in intensive care or after intensive care, especially if you suspect medical negligence. And don’t let anybody tell you, you can’t access medical records while your loved one is in ICU. That is a right, not a privilege. We can help you with accessing medical records. There’s no issue.
Also, of course, if you have a loved one in intensive care and you want to go home, go to intensivecareathome.com. Again, we are predominantly providing services in Australia at the moment from all major metropolitan areas, Melbourne, Sydney, Brisbane, Adelaide, and Perth, NDIS funded, but also TAC, iCare, DVA funded. You should contact us. Don’t worry about the funding aspect. We can help you with the funding side of things. We have done it many, many times for our clients.
Please like the video, share the video with your friends and families, and of course subscribe to my YouTube channel for regular updates for families in intensive care, click the notification bell, and comment below what you want to see next or what questions and insights here from this video.
Thanks for watching.
This is Patrik Hutzel from intensivecareathome.com.
I’ll talk to you in a few days and with another YouTube live stream next Sunday, 11:30 AM, Sydney Melbourne Time, which is 7:30 PM Eastern Standard Time in the U.S. on the Saturday night.
Take care for now.
Now, if you have a loved one in intensive care and you want to go home with our service intensive care at home and if you want to find out how to get funding for our service and how it all works, please contact us on one of the numbers on the top of our website, or send me an email to [email protected] That’s Patrik, just with a K at the end.
Please also have a look at our case studies because there we highlight more about what we can do for clients, how clients can live at home with ventilation and tracheostomies and you can look at our case studies as well at our service section.
And if you are at home already and you need support for your critically ill loved one at home, and you have insufficient support or insufficient funding, please contact us as well. We can help you with all of that.
And if you are an intensive care nurse or a pediatric intensive care nurse with a minimum of two years, ICU or pediatric ICU experience, and you ideally have a critical care certificate, please contact us as well. Check out our career section on our website. We are currently hiring ICU and pediatric ICU nurses for clients in the Melbourne metropolitan area, Northern suburbs, Sunbury, Bendigo, Mornington Peninsula, Bittern, Patterson Lakes, Frankston area, South Gippsland, Drouin, Warragul, Trida, Trafalgar and Moe as well as Wollongong in New South Wales.
So we are also an NDIS (National Disability Insurance Scheme), TAC (Victoria) and DVA (Department of Veteran affairs) approved community service provider in Australia. Also have a look at our range of full-service provisions.
Thank you for watching this video and thank you for tuning into this week’s blog.
This is Patrik from Intensive Care at Home and I’ll see you again next week in another update.