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One frequently asked question we get here at Intensive Care at Home, is how to survive with a tracheostomy in the neck?  That’s a question we get all the time, and today I want to give you the answer. My name is Patrik Hutzel from intensivecareathome.com.

Some patients in intensive care end up with a tracheostomy, and then they can’t have it removed, and that’s what we specialize in here at intensivecareathome.com. We look after tracheostomy and ventilated clients in the community, adults and children.

Living with a tracheostomy, obviously, requires careful management to ensure breathing, hygiene, and overall health. Here are some key tips and strategies that we implement on a day-by-day basis, sending our critical care nurses into the home, 24 hours a day, for tracheostomy and ventilation.

Number one, the tracheostomy tube needs to be clear, of course. Regular suctioning needs to happen to prevent mucus and sputum buildup. Use humidification, dry air can cause thick secretions and irritation. Cover the tracheostomy. Use an HME (Heat and Moisture Exchanger) filter, that is only if a patient can be off the ventilator, only then can you use the HME filter to prevent dust and infection. The exception there is that when patients are ventilated, and if they are going out, if they are mobile and leaving their home, then they have an HME filter through the ventilator so that the air and oxygen are humidified. Otherwise, secretions can dry up quickly.

Then, you need to avoid water, of course. If water enters the tracheostomy, that could cause aspiration pneumonia. Tracheostomy stoma needs to be cleaned daily, ideally multiple times a day at least twice, sometimes three times a day, and that can be done with a sterile dressing pack, sterile gauze, and normal saline. Change the dressing and ties, of course. Keep the area dry and free from moisture buildup to prevent infections and skin breakdown. Watch for infection signs, redness, swelling, pus, or fever need medical attention, any redness around the tracheostomy site.

If patients can be off the ventilator, you might use a speaking valve, but only if the tracheostomy cuff can go down or if it’s a cuffless tube, only then is talking really an option with a speaking valve. Obviously, other ways to communicate is through computers, whiteboards, apps, and text-to-speech devices, that all helps with communication.

Next, eating and drinking, check swallowing ability. Some may need modified diets or therapy. If a patient can swallow and eat, once again, that’s only if the cuff can go down or if it’s a cuffless tracheostomy. Very few patients can eat and drink with a cuffed tracheostomy, but I have seen it on the odd occasion. Of course, avoiding aspiration is really important. Again, it is much less likely to aspirate with the cuff up and much more likely to have it with the cuff down if a patient can’t swallow. But a swallowing assessment needs to happen from a speech pathologist.

More importantly, let’s talk about emergency preparedness. Always carry emergency equipment with you. If it’s a size 8 tracheostomy, for example, you need a similar size 8 tracheostomy ready to go. You also need a size smaller, size 7 for example, in case you can’t get the size 8 back in if a tracheostomy comes out. Tube suction catheters and a manual resuscitation bag. Know how to replace the tracheostomy if it dislodges, reinserted, or seek emergency help. Inform family and friends. Teach them basic tracheostomy care in case of emergencies. But you shouldn’t teach family and friends because it’s a critical care nursing skill, really. It is a critical care nursing skill. Do not teach families and friends.

When you look on our website at intensivecareathome.com, you will see the Mechanical Home Ventilation Guidelines that are evidence-based. If they’re evidence-based, it says only critical care nurses with a minimum of two years of critical care nursing experience can safely look after tracheostomy and ventilated clients in the community, adults and children. But it is important that the critical care nurses know how to change the tracheostomy in an emergency and how to keep an unstable airway stable. That is really important.

Like I said, there need to be suction catheters, suction machines, extra oxygen, and humidifiers, that all needs to be there. Also, a tracheostomy dilator, just in case the tracheostomy collapses if a tracheostomy comes out in an emergency. Ambubag face mask, Comfeel dressing, or Tegaderm dressing to seal the tracheostomy so that someone can bag with a bag-valve mask to maintain a stable airway.

Also, what I haven’t said, even with a tracheostomy in the neck, you can go out with a team of critical care nurses like we do at Intensive Care at Home. All of our clients have community access. So, they live their lives, they go shopping, they go to the movies, and they visit their relatives. That’s when the HME filter is important. If someone is not ventilated or if someone is ventilated, the HME filter needs to be in the circuit. It’s also important that when patients or clients go out, they take an emergency pack with them, spare tracheostomies, and everything that I mentioned to be prepared for any potential emergencies.

I hope that answers your question today in terms of what to do and how to survive with a tracheostomy in the neck, whether with or without a ventilator.

With Intensive Care at Home, we’re currently sending our critical care nurses into the home 24 hours a day. Therefore, we are providing a genuine alternative to a long-term stay in intensive care for ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy, tracheostomy without ventilation, Home TPN (Total Parenteral Nutrition), home IV potassium infusions, home IV magnesium infusions, IV fluids, and IV antibiotics. We’re also providing ventilation weaning at home. We’re also providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as a port-a-cath management at home. We’re also providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home, as well as palliative care services at home.

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home instead of going to the emergency department.

Therefore, we’re also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs around $5,000 to $6,000 per bed day. Our service costs between $2,500 to $3,000. We’re freeing up the most sought after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders.

With Intensive Care at Home, we’re currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We are an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland, as well as the Department of Veteran Affairs (DVA) all around Australia. Our clients and we as a provider have also received funding through public hospitals, private health funds, as well as departments of health.

We are the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home in 2025. We have been achieving this high level of accreditation since 2012. No other provider has achieved this high level of accreditation in the community and has created more intellectual property for Intensive Care at Home nursing than we have. This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do, which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this and you realize you don’t have the right level of support, or if you’re stuck in an ICU long-term, or if your family member is stuck in an ICU long-term, I’ll give you a very tangible example today. One of our first clients about 10 years ago, when we first got started, was a client who was at home, initially on a ventilator with a tracheostomy, with a support worker model 24/7. Of course, support workers cannot look after a client at home on a ventilator with a tracheostomy safety. That is like flying the airplane with a cabin crew instead of the pilot, because anyone on a ventilator with a tracheostomy is at very high risk of medical emergency or dying if they don’t have a team of critical care nurses looking after them 24/7. This is evidence-based and is documented in our Mechanical Home Ventilation Guidelines that you can find on our website.

Think about it, in an intensive care in a hospital, you wouldn’t have support workers look after a critical care patient on a ventilator with a tracheostomy, so why would anyone in their right mind do that in a home care environment in the community?

So eventually, this client found out about us, we were proving our concept with this client very fast. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never went back into ICU ever again, and we were proving our concept there very fast.

We can do the same for you if you’re not safe at home, which includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business. The same is applicable for those stuck in ICU, similar to our case, to what you’re looking for. Reach out to us, we’ll make it happen for you as well. We can take you through the right steps.

This is also why we’re providing Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS Support Coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog below the video. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

If you’re a NDIS Support Coordinators or a case manager from another organization watching this and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for nursing care for your participants, and you don’t know how to go about it and what evidence to provide, I encourage you to reach out to us as well. We can help you with the right level of funding and with the right level of advocacy.

We’re also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

If you’re a critical care nurse and you’re looking for a career change, and you want to join a very progressive, dynamic, and high performing team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined. If you’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I have a disclaimer, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again, because they are so vulnerable and so special, and that’s why we need regular staff. So, if you’re looking for agency work where you can come and go, this will not be the right fit for you. We’re looking for consistency, and our clients are looking for consistency. So please, only apply with us if you can give us a regular and consistent availability for shifts, and you’re really keen on building relationships with us and with our clients.

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well. We can also help you eliminate your bed blocks in ICU and in your ED for long-term patients or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds, and in most cases, you won’t even pay for it. Even if you do pay for it, it is much more cost-effective than what you’re paying in ICU and ED for, and you get the same level of care.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, Home TPN, of course, please reach out to us as well. We can help you eliminate your bed blocks fast.

If you’re in the U.S. or in the U.K. and you’re watching this and you need help, we want to hear from you as well. We can help you there privately with one-on-one consulting and hiring nurses privately.

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or simply send us an email to info@intensivecareathome.com.

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

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.