Can My Husband with Tracheostomy & PEG (Percutaneous Endoscopic Gastrostomy) Go Home from ICU Without 24/7 Critical Care Nurses?

Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and 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 adults and children with tracheostomies, medically complex patients, adults and children at home, BIPAP (bilevel positive airway pressure), CPAP (continuous positive airway pressure) ventilation at home, and also for adults and children that are not ventilated but have a tracheostomy, and also Home TPN (total parenteral nutrition), Home IV potassium infusions and Home IV magnesium infusions, as well as palliative care, and IV antibiotics, which includes PICC (Peripherally Inserted Central Catheter) line, central line, Hickman’s line, and Port-a-cath Management at home as well.

In last week’s blog, I talked about,

ICU DOCTORS ARE TELLING ME MOM WON’T BE ABLE TO GET OFF VENTILATION & TRACHEOSTOMY, CAN SHE GO HOME?

You can check out last week’s blog by clicking on the link below this video:

https://intensivecareathome.com/icu-doctors-are-telling-me-mom-wont-be-able-to-get-off-ventilation-tracheostomy-can-she-go-home/

In today’s blog post, I want to answer a question from one of our clients and the question today is

Can My Husband with Tracheostomy & PEG (Percutaneous Endoscopic Gastrostomy) Go Home from ICU Without 24/7 Critical Care Nurses?

Now, today, I want to answer a question from one of our clients who’s also a member of our membership for families of critically ill patients in intensive care. We help families, not only with Intensive Care at Home, we also help families that have a loved one in intensive care by answering their questions, by advocating for them.

We have a membership for families of critically ill patients in intensive care at intensivecarehotline.com when you click on the membership link there or by going to intensivecaresupport.org directly.

But without further ado, let’s read out the question from one of our members who has their husband in ICU on a tracheostomy and a nasogastric tube. She wants to take her husband home, but obviously it needs to be safe, and we are guiding her how to get her husband home safe.

So, let’s just read out the email from our member who says,

“Hi, Patrik and team,

My husband is still in the hospital. He completed the FEES (fiberoptic evaluation of swallowing) test last week, Thursday. The speech pathologist stated that his swallowing muscles are weak, so they will be implementing exercises for him to do. The speech pathologist has advised swallowing with a few pieces of ice daily by the nurses.

His oxygen level is 100%. His heart rate can be high at times, so he’s been given metoprolol as needed to get his heart rate down. I think he needs magnesium glycinate to control the heart rate. He was prescribed that at Emory Hospital, but the doctor states his magnesium level is good, or he could be deficient in taurine is my opinion. The speech pathologist worked with my husband on Monday only. Hopefully, she will work with him more often.

I’m torn between whether he should go to rehab or whether I should take him home. But the rehab facilities don’t seem to have any beds at this time, and they also seem to be out of their depth with a tracheostomy and a nasogastric tube.

I told the case manager yesterday that there are many things a tracheostomy patient should have in place before going home.”

Exactly. That’s exactly right and that is what we are here for with Intensive Care at Home, making sure that your husband can go home safely.

“Now, the doctors and nurses work with him now aggressively to get him weaned off the tracheostomy by ensuring he uses the Passy-Muir valve more often so that he can be decannulated soon.

He now has the PEG (Percutaneous Endoscopic Gastrostomy) tube instead of the nasogastric tube. He still has some ICU delirium, but he’s now getting also more alert and responsive. His pressure wounds are getting changed every 12 hours and they’re looking more and more healthy.

He’s scheduled to do the hyperbaric therapy soon. Once discharged, we had to reschedule because he is still hospitalized. I know the hyperbaric therapy is good for everything including the traumatic brain injury.

Physiotherapy at the moment doesn’t work with him as often as they should do. I will hope that’s going to change as well because getting him home means I will have to have more and more physical therapy or physiotherapy for him at home so he can get stronger and stronger.

I would like to take him home. What do you think?”

So, this is from Anne Marie, one of our members. Anne Marie, we had this discussion before, it is really important that before your husband is going home, you’ve got all your ducks in a row.

So, what that means is if he’s going home like he did last time without ICU nurses, he will bounce back into ICU in no time. It didn’t even take 24 to 48 hours. I know you want to try again this time around, which is fine. We are not discouraging you from going home.

We are discouraging you from going home without the right resources. So, what that means is he needs critical care nurses, 24 hours a day. If he doesn’t have critical care nurses, 24 hours a day, quite frankly, he’s at risk of dying and I’m not exaggerating here.

For example, if you look at the Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com, you will see that the evidence-based Mechanical Home Ventilation Guidelines clearly say that there needs to be a critical care nurse at home, 24 hours a day, with a minimum of two years critical care nursing experience.

Those are exactly the staff we employ at Intensive Care at Home. None of our nurses comes with less than two years ICU or ED or pediatric ICU experience because that is what is needed at home to make a transfer for your husband safe, and those Mechanical Home Ventilation Guidelines are evidence-based.

The evidence-based Mechanical Home Ventilation Guidelines are a result of over 25 years of Intensive Care at Home nursing in Germany and over 10 years of Intensive Care at Home nursing in Australia. So, the proof is in the pudding that anything less than 24 hours nursing care with a critical care nurse with a minimum of two years critical care nursing experience is simply dangerous.

Case in point, we have looked after some clients at home where the funding bodies or the insurances were only paying night shifts for clients similar than your husband. They weren’t necessarily ventilated, they just had a tracheostomy and a PEG tube, and they were funding night shifts with a critical care nurse, but they weren’t funding a critical care nurse during the day. Just as we predicted at the time that these people are at risk of dying.

Unfortunately, those people died when we were not there because medical emergencies with a tracheostomy could not be managed by either family members, by support workers, or even by registered nurses who are not critical care trained.

So, by you going home without having that in place will be a failure waiting to happen just like you’ve seen last time when you went home prematurely.

So, what else needs to happen? What else need to happen is you need to have equipment in place, which you didn’t have last time either. You need to have all the right equipment in place like suction machine, a monitor, oxygen, nebulizer, humidifier. You need a hospital bed. You probably need a lifting machine or a hoist until your husband is strong enough to get mobilizing again. You need a feeding pump and so forth, but we have a list of equipment that you need, and we can help you with that.

But more importantly, what you also need now is you need the funding, you need the health insurance or the NDIS (National Disability Insurance Scheme) to pay for this, which they will. We just need to approach it in the right way. We’ve always helped our clients to get the funding. There won’t be any issue around this as long as the advocacy is streamlined, and the right case is put in front of the funding body. At the moment, the ICU bed costs them $5,000 to $6,000 per bed day. Intensive Care at Home is approximately half of the cost.

Then, we also need to look at continuing speech therapy at home, continuing physiotherapy at home. But that can all be set up to keep working towards a decannulation for your husband. So, I hope that helps.

With the high heart rate and him being on metoprolol, that might help to get his heart rate down, but he might simply have a high heart rate because he might be in pain. Have you considered that? He might be dehydrated, have you considered that? He might simply be brewing an infection, have you considered that?

So, I hope that answers your questions here, Anne Marie, what needs to happen next?

Please, don’t take him home prematurely because your husband will be at risk of dying or being readmitted back to hospital and to ICU in no time, just like what happened last time when he went home without the right support.

We can set it up for you step-by-step and work with you step-by-step so your husband can improve his quality of life at home, and you can also improve your quality of life, so you no longer have to live in ICU, day and night.

Thank you so much for sending through that question and for letting me help you with this.

So, with Intensive Care at Home, we are an NDIS approved service provider all around Australia, TAC (Transport Accident Commission) approved service provider in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as the DVA (Department of Veteran Affairs) all around Australia. We also have received funding through public hospitals, departments of health, as well as private health insurances.

We’re currently operating all around Australia in all major capital cities, and in all regional and rural areas. If you are watching this and you are in the U.S., we can help you in the U.S. privately. Please contact us as well and the same in the U.K., we can help you privately.

If you have a loved one in intensive care in a similar situation or, you are watching this and you’re a patient yourself in ICU, please contact us by sending us an email to [email protected] or by calling us on one of the numbers on the top of the website.

Also, you might be at home already on a ventilator with a tracheostomy, you’re not ventilated but you have a tracheostomy, you might need IV antibiotics, you might need palliative care, you might need IV potassium infusions, you might be on BIPAP, CPAP, seizure management and you have insufficient support, and you have insufficient funding, please contact us as well if you need help.

If you are an NDIS Support Coordinator and you need help with nursing care for your very complex nursing clients or you don’t know how to get nursing funding for your clients, please contact us as well or if you’re a case manager in hospital or a social worker, please contact us as well.

We are also offering our own Level 2 and Level 3 NDIS support coordination for our NDIS clients. If you need help there, please contact us as well.

If you are an intensive care nurse or a pediatric intensive care nurse or an ED nurse with a minimum of two years critical care nursing experience, ideally with a postgraduate critical care qualification, please contact us as well.

We currently are hiring critical care nurses in Sydney, Melbourne, and Brisbane. We’re also hiring in the Warragul area, South Gibson in Victoria, as well as in Bendigo in Victoria, as well as well as in Albury Wodonga on the New South Wales, Victorian border.

Now, if you are an intensive care doctor or an intensive care specialist, and you’re looking for a career change, we are currently also expanding our medical team.

If you’re an intensive care specialist and you’re working in ICU and you have bed blocks with your long-term ICU patients, you know where we are to help you eliminate your bed blocks and more importantly, improve the quality of life and quality of end of life for your patients and families.

If you are a hospital executive watching this and you have bed locks in your hospitals for long-term ventilated patients with tracheostomy, et cetera, we can help you managing your beds in hospital as well.

Also, we are currently providing an ED bypass service for the Western Sydney Local Area Health District. We can provide the same for your ED in your hospital so that your ED is not overrun, and we take the pressure off your ED, by sending CCRNs into the home and keeping them at home before they come into ED. So, we are avoiding hospital readmissions there as well.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home, click the like button, click the notification bell, comment below what you want to see next or what questions and insights you have from this video, share the video with your friends and families.

Thank you so much for watching.

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

Take care for now.

YOUR INTENSIVE CARE AT HOME

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