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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
Living with Ventilator and Tracheostomy at Home, Some Real-World Adult and Pediatric Case Studies!
Wherever you are, welcome to another Intensive Care at Home live stream. Thank you for joining me today. I want to welcome you.
So, today’s live stream is about, living with ventilation and tracheostomy at home, some real-world adult and pediatric case studies. That’s what I want to talk about today. Before I go into today’s topic, just a couple of housekeeping issues. Please type your questions into the chat pad, keep them on today’s topic. But any other questions you have that are not related to today’s topic but are related to Intensive Care at Home or intensive care questions in general, please type them in at the end of the presentation, and you can also dial into the show later today.
Good morning, Isaac. Nice to see you.
Now, before I go into today’s topic, you might be wondering what makes me qualified to talk about today’s topic. I have worked in intensive care for over 20 years. I’m a critical care nurse by background. Out of those over 20 years, I have worked for over five years as a nurse unit manager in ICU and I have worked with Intensive Care at Home now for over 10 years. I have done Intensive Care at Home 20 years ago in Germany, we were successfully pioneering this concept in Germany. And as I was starting my travels, worked in the UK and then came to Australia, I realized that no such thing exists and I got it started here in Melbourne, Australia, but we are now slowly also branching out into Sydney and into Brisbane. And we’re serving a growing client base in the Melbourne metropolitan area, but also in country Victoria.
And I know we probably have people here today, that are dialing in from the U.S. as well and maybe from the U.K., and I can talk about what’s happening in the U.S. and the U.K. as well. Okay, so that’s a little bit of background. Let’s start with some case studies on some of our clients at home that we looked after over the years or that we still look after at present. I will be talking about past and present clients.
So the overwhelming majority of our clients are clients with tracheostomy and are ventilated. Some of our clients are ventilated via BiPAP, CPAP or VPAP with a mask. They don’t have a tracheostomy. Some of our clients have a tracheostomy but are not ventilated. Some of our clients are not ventilated at all, but still need an intensive care nurse 24-hours a day. For example, there might be seizure management involved. There might be still an unstable airway because when patients have seizures or when clients have seizures, their airway might become unstable. We have a client that stops breathing regularly even though she’s not ventilated. But we obviously then need to manage an unstable airway in a home care environment. And some of our clients are on home TPN. Again, they’re not ventilated, but they still need a critical care nurse for some of the time because they are on home TPN. For those of you that don’t know what TPN is, TPN stands for total parenteral nutrition, which is also known as intravenous nutrition.
Now, in a hospital setting, the IV nutrition needs to be given by a central line or via a PICC line or via a Hickman’s line. And again, that requires the skill of an intensive care nurse, there’s often also some electrolyte monitoring going on again where we need to take regular bloods and monitor that.
But let’s go into what is probably bread and butter for us, and that’s also how we got started in the early days with taking clients home from intensive care with ventilation tracheostomy. They’re, generally speaking, rather stable. They’re not on any inotropes, not on any vasopressors. They’re out of the induced coma, but they have an inability to be weaned off the ventilator. The options for those people are very limited because they’re either stuck in ICU.
Or what many ICUs still do to this day, is that ICUs think that people won’t have any quality of life and that it’s “in their best interest” to start palliation or to withdraw treatment. And you will see as I go along with some case studies today that people actually do have quality of life. And maybe there comes a day when on a live stream like this I can actually invite some of our clients. But our clients are very private and they don’t want to be in the limelight, and I can understand why. But maybe one day we will have someone coming on to the show here that can give firsthand testimony. But again, I appreciate that our clients are very private and they don’t want to have themselves or their loved ones in the limelight, let alone on a live stream.
Their lives are difficult enough as it is, and just for today I want to talk about it. Maybe I should just go back in time. Again, I was doing this type of work 20 years ago in Germany and we were looking after a large number of ventilated clients at home, pediatrics and adults from the toddler, to the five-year old, to the 45-year old, to the 79-year old. So came in all forms and shapes and sizes. And everyone that we looked after and still to his day is very grateful for the work we are doing because we are keeping clients out of ICU, we’re giving them a second chance at home and they can be with their families
). And that’s priceless. That’s absolutely priceless. If I was to put a monetary value on our service, I simply can’t. I still do some of the marketing about that. We cut the cost of an ICU bed by half.
And whilst that’s true, I do believe that our service is absolutely priceless. Ask our families, ask our clients where they would want to be. Would they want to be at home 24 hours a day, or would they want to be in ICU 24 hours a day? Would they not want to leave? I mean you can paint the picture for yourself. Okay, let’s go back in time quickly.
About 10 years ago when we first started out, our first client here in Melbourne was actually at the time a 36-year-old man who had a C1 spinal injury when he was actually six years of age. So fully quadriplegic, ventilator-dependent with a tracheostomy. And that’s how we got our feet on the ground here initially. This client was going back to ICU all the time because he didn’t have ICU nurses at home.
And because he was going back to ICU all the time, he needed ICU nurses to live at home rather than spending all of his time in ICU. And that’s how we got our feet on the ground. That’s how we proved the concept very quickly, that with 24-hour ICU nurses, you can actually keep people out of ICU, provide them with quality of life at home instead of going to ICU. And again, this client was forever grateful. He had a van and he was able to go out. We were going actually on holidays with him. We were flying with him over to Alice Springs, which is in the center of Australia, but we were also going away on weekends to holiday areas here. And that’s the alternative. Otherwise he would’ve lived in ICU. And that’s all possible for someone on a ventilator with a tracheostomy if you have the right support in place.
And that’s what it all comes down to. We’re basically setting up a mini ICU at home with all the equipment. You have a ventilator, you have a spare ventilator, you have a monitor, you have a spare monitor, you have a suction machine, a spare suction machine, you have the tracheostomies, you have the spare tracheostomy, you have the resuscitation bag, a tracheostomy dilator or tracheal dilator. You just set it up like you would set up an ICU and you have the relevant people around you. So that’s how we got started. We then carried on providing some, you know, in the early days when we were reasonably small, provided palliative care to some clients at home with tracheostomy, with ventilation. We had a mixture of adults with tracheostomy on the palliative care, also ventilated, but also we had some children. We were doing work here in the early days for palliative care at the children’s hospital here in Melbourne, where we were providing palliative care to pediatrics at home.
That was incredibly challenging but also incredibly rewarding work that we did. That included, for example, a one-way extubation at home. So, what that means is, in ICU whether it’s for children or whether it’s for adults, a “one-way extubation” is when you take out the breathing tube for palliative care with the expectation that a patient will pass away after you remove the breathing tube. And those situations sometimes have their time and their place. And when I worked in ICU over the years, I could not believe how many families that I’ve met that said, “Okay, all right, we need to do a one-way extubation. We expect our loved one to die.” How much nicer would that be if we could do that at home? Again, who wants to die in an ICU? Who wants to have that end-of-life in ICU, if you can do it at home?
And of course, if the family wants that, some families still would want that end-of-life situation in ICU, and that’s fine too. But from my perspective, people need to have an opportunity. They need to be given options. It’s not a one size fits all, and that’s what it’s all about. Anyway, so that’s how we sort of made our mark in the early days. And then as we were growing, we got the right people on board. We then continued, for example I remember with a three-year-old boy who had a cardiac arrest and had sustained a hypoxic brain injury from that cardiac arrest. And he ended up on BiPAP in ICU. He didn’t have a tracheostomy, but he ended up on BiPAP for a long period of time after the cardiac arrest. And he was stuck in ICU and couldn’t go home until the children’s hospital at the time and the Department of Health approached our service to take this little boy home until he could be weaned off the BiPAP, which he could after about 12 months.
But again, we have freed up at the time a pediatric ICU bed. We managed to look after the little boy at home for a good 12 months until he was actually discharged from our service because he didn’t need BiPAP any longer. That was a real success story. At the same time, we were looking after an 18-month-old boy who was a prem baby, who spent the first year in NICU (Neonatal ICU) and then in pediatric ICU. Again, could not go home because he couldn’t go home because he had nowhere to go to. No services would take him, the family would’ve felt overwhelmed in looking after him with a tracheostomy at home. We took him home with our service and about six months later he got decannulated. Again, another success story where we enabled a little boy going home from neonatal ICU and pediatric ICU and then he got decannulated.
And there was a little girl at the time as well. She was around the same age, again, pre-mature baby, very similar situation where we managed to get the baby home. And she was stuck in ICU for the first 12 to 18 months of her life, and then we managed to get her home and then took about six months to look after at home until she got decannulated. So again, great success story there. Having said that, most of our clients, especially our adult clients, are sort of under palliative care. Some of it is end of life care, some of it is simply maintaining their quality of life. But at the end of the day, they are on a ventilator with a tracheostomy. And I talked about our very first client who was a C1 spinal injury, a young man, a 35-year-old man. We are currently looking after another C1 spinal injury. A young man, he’s about 20 after a motor vehicle accident.
Again, he’s a young man, there’s nothing wrong with him besides him being quadriplegic. He’s a young healthy man, but obviously he is on a ventilator with a tracheostomy. But again, what’s the alternative for anyone on a ventilator with a tracheostomy? The alternative is for them to live in ICU or potentially end of life. Well, with our service, we can look after them at home. And again, those people, generally speaking, report a good quality of life. I don’t know whether any of you has seen any research or statistics. There’s research and statistics out there that after some major event in people’s lives, especially a traumatic event after a major sickness, major disability, that the level of happiness after a while actually goes back to the level of happiness pre-accident. And I think that’s actually what we are seeing with the majority of our clients that they can live at home and report a good quality of life. Look, like with anybody else there can be many ups and downs of course. Their lives are challenging irrespective. But again, with the right support, with 24-hour intensive care nurses at home, it can be done.
So other clients were looking after at home are clients with motor neurone disease, for example. So when you look at motor neurone disease in general, it’s a progressive neuromuscular disease and that progresses eventually to where people need ventilation. It usually starts off with noninvasive mechanical ventilation with CPAP or BiPAP. And then what often happens is once patients are on BiPAP with motor neurone disease, they often end up with an aspiration pneumonia. They have a PEG tube already. They’re getting fed through the PEG tube, and with BiPAP and PEG feeds, there’s definitely an increased aspiration risk just simply because patients don’t have a… I’m trying to think of the word now, they don’t have the esophagus restricted. I’m thinking of the technical term now and I can’t think of it, but it’ll come to me. But there’s certainly increased aspirational risk, and then many patients with a motor neurone disease end up with aspiration pneumonia.
They are then faced with the challenge of needing to be weaned off the ventilator with the breathing tube. And then the next step often is a tracheostomy. And then again, this is where our service kicks in. The service really needs to kick in when patients are on BiPAP or on CPAP. But then when patients with motor neurone disease end up with a tracheostomy, that’s when they can go home with our service Intensive Care at Home and which is some of our clients actually are at home on ventilation with motor neurone disease. I want to talk about one specific man in particular who is around 45 or 46 years of age. He got diagnosed with motor neurone disease about six or seven years ago.
And after exactly what I just explained, he was on BiPAP, ended up with an aspiration pneumonia, ended up in ICU with a breathing tube, had a tracheostomy. We then took him home and he’s been at home now for close to three years. I think it’ll be three years in October. And for this man in particular, he’s got an 8 or a 9-year-old son, he lives with his wife and they enjoy every minute of their life that they have together. And it’s just nice to be part of that and it’s nice to enable that for this family in particular.
Other clients that we look after at home sort of to illustrate what other clients will look after at home is, for example, cerebral palsy. So, we have some cerebral palsy clients. They’re usually young boys, but there’s also a young girl that we are looking after. They’re usually in their late teens, early 20s. Most of them are all on BiPAP ventilation. One of them is ventilated with a tracheostomy.
So it really depends on how their cerebral palsy unfolds in terms of do they need a tracheostomy, do they not need a tracheostomy? But at the very least, they usually need BiPAP. They usually need regular airway clearance with an NPA, nasopharyngeal airway, deep suctioning. They usually need seizure management as their airway can become unstable fairly quickly. They’re at high risk of aspiration pneumonia again, and that’s why they need an intensive care nurses 24 hours a day. They usually have a PEG tube and that’s why they need 24 hours ICU nurses. Because if they don’t have that, they would bounce back into ICU. And we know what ICUs are like at the moment. ICUs had no beds before COVID. And now with COVID, there are no beds in ICU. So the best place for those clients to be looked after is at home with 24 hours intensive care nurses.
Other case studies that I can give you is also a couple of motor vehicle accidents that actually don’t have a C1, but they have a C2 spinal injury and fairly similar to C1 spinal injury, high spinal injury ventilator-dependent tracheostomy. But again, the 24 hour intensive care nursing is keeping them at home. Other clients we looked after and we still look after at home are children for example with SMA, spinal muscular atrophy. Most of them are BiPAP dependent. They don’t have a tracheostomy at this stage. They’re BiPAP dependent. They often also need a cough assist machine, again to clear their airway. They might need frequent suctioning. SMA, just very quickly, spinal muscular atrophy. Up until about four or five years ago, that was pretty much a death sentence for those kids, and the life expectancy was somewhere between 9 to 12 years of age.
Now a new trial drug has come on the market. It’s actually called Spinraza. Let’s call it Spinraza. And that trial drug is actually saving the kids’ lives and life expectancy is going up, which is great. And we see big improvements with our clients even though they still need intensive care nurses to keep them safe, especially when they’re on BiPAP.
Now let’s also talk a little bit about evidence-based. So why are we doing what we are doing and is it evidence based? Because when you talk about treatment therapy in hospitals, it always needs to be evidence-based. Now, Intensive Care at Home is not any different from providing evidence why it’s necessary reasonable and evidence-based of what we’re doing. So, when you look on our website, there’s a section on our website called the Mechanical Home Ventilation Guidelines. And it’s a fairly long document and it’s a result of gathering evidence over the last 20, 25 years, particularly in Germany, but also now in Australia, that the only way to keep clients safe at home is with intensive care nurses 24-hours a day.
And those intensive care nurses need to have a minimum of two years ICU or pediatric ICU experience. And that’s exactly what we’re doing with Intensive Care at Home. And that includes, it’s not only for mechanical ventilation and tracheostomy which is referred to as invasive ventilation. It also is for a noninvasive ventilation, again, such as BiPAP, CPAP, VPAP and it’s also for clients that only have a tracheostomy. And the evidence to me is crystal clear. And why is the evidence to me crystal clear? We have taken so many patients home from intensive care now that we couldn’t be doing that without intensive care nurses. You can’t take someone home from intensive care on life support without intensive care nurses 24 hours a day. It’s a no-brainer. That’s number one. Number two, we are doing a lot of advocacy for our clients and I’ll come to funding sources in a minute and talk a little bit more about advocacy.
But before I talk about advocacy, unfortunately, we have evidence that some clients have passed away in the community because they were taken home on a ventilator or with a tracheostomy and they didn’t have intensive care nurses 24 hours a day. And of course they died because medical emergencies could not be managed by families, by support workers, even by general registered nurses. Again, you need to have an intensive care nursing background, a solid intensive care nursing background to manage patients on a ventilator with a tracheostomy or anything that’s medically complex. Again, there’s evidence for that. There’s not only the evidence that it needs to happen that way, unfortunately, there’s also the tragic evidence that people have died because it wasn’t managed that way. So it’s very sad what we’ve seen, but obviously we’re doing a huge amount of advocacy in order to make it safe for our clients.
Now, I briefly mentioned that all of our nurses need to have a minimum of two years ICU or pediatric ICU experience. Now, I can assure you here that most of our nurses have around 8 to 10 years ICU experience on average. We have some nurses that have worked in ICU for five years. We have some nurses working for us that have worked in ICU for 30 years. So I’m not making it up when I’m saying we’re employing hundreds of years of ICU nursing experience in the community. And I do believe that we are worldwide, the only provider at the moment that sends intensive care nurses into the community to free up intensive care beds and to provide quality of life at home for our clients. And it’s still unique to take intensive care nurses and use that skill in the community, but clearly as we’ve shown, there’s a clear demand for that. There’s a clear market for that. The value proposition is too high to be ignored.
And I just want to talk about other clients, because we had just started recently with another client actually with myasthenia gravis, which again is a neuromuscular disease. It’s also an autoimmune disease. And this lady is on BiPAP at home. And again, that’s sort of also a client that we are looking after at home as well.
Now let’s talk a little bit about the advocacy and let’s talk a little bit about the funding. And I will also address our friends in the U.S. in a minute, but let’s just talk about the Australian environment first. So most of our funding at the moment, or I should say most of our clients’ funding. It’s not our funding, it’s the client’s funding, is coming through the NDIS, the National Disability Insurance Scheme. Some of it is coming through the TAC here in Victoria, the Transport and Accident Commission, and some of it is coming from the DVA, the Department of Veteran Affairs. We’re also getting some direct funding from hospitals. But that sort of has become less and less since the NDIS has kicked in. Now, whilst I’m mentioning all these insurance scheme, they have come a long way. By the same token, the NDIS in particular has still a long way to come. And if anyone is watching this video from the NDIS, please consider medical and clinical evidence. Consider that NDIS can be responsible for client’s deaths if they’re not getting the right support. But also consider that the NDIS can be a vehicle of helping the hospital system to manage ICU beds and more importantly provide quality of life for patients on ventilation, tracheostomy, non-invasive ventilation or a TPN.
And as long as the medical evidence or clinical evidence and nursing assessments are done properly, we are finding that patients or clients get what they want even though it’s always under scrutiny. And we have certainly also seen that the NDIS is trying to cut funds which can result in client’s deaths and it’s terrible. But again, we have a very good understanding about the advocacy process that needs to go in, especially with the NDIS, but also with other funding bodies, and you should 100% contact us if you’re in Australia and you want to know about funding. You should contact us through our website. Just contact us on our Australian number and we can help you with funding. We can help you with explaining the process in more detail. We can help you in either sending you ICU nurses if your loved one wants to go home, or if you want to go home, or if you’re at home already and you’re finding you’re not getting the support, you’re bouncing back into ICU.
Or if you feel like the levels of support you’re having is not safe, you should contact us as well. Yeah, let’s just quickly talk to our friends in America. We have a lot of inquiries from the U.S. as some of that are watching this. It’s still a challenge for us to provide services in the US. We need a home care license, which we don’t have at the moment, but we are having two providers at the moment that we can suggest. One of them is in New York, in Brooklyn in particular, and one of them is in Virginia. And we had good experiences by referring clients on to those providers, and we are happy to keep making recommendations there. The trouble is that both providers are limited in their geography. I.e. our Brooklyn friend is only sort of in the New York City area, including Brooklyn. In Virginia, they’re sort of mainly on the coastal area, Virginia Beach, Norfolk.
So they are geographically limited, but we have made some referrals and our clients there say they’re really good. And we want to continue that partnership, of course, because we want to help people wherever we can. And obviously as some of you know in the U.S. as well, and also applicable for Australia, you should check out intensivecarehotline.com where we are providing a consulting and advocacy service for families in intensive care. So you should definitely contact us there. If you have issues, questions, if you have a loved one in intensive care, you should definitely reach out through us through Intensive Care Hotline as well. Now I should also say quickly coming back here in Australia, we are nationwide now. It doesn’t matter where you are, you should definitely contact us nationwide in Australia on our 1300 number on the top of our website at intensivecareathome.com.
Or you can send us an email at [email protected]. Now we also have inquiries from the UK. Again, there’s probably a little bit more in the UK. I have worked in the UK myself way back when. There’s probably a little bit more in the UK that can provide this type of service. Not enough, not enough specialized services at all, but there is definitely something out there in the community. And again, you should contact us. We can probably recommend you to someone in the UK as well. Talking about U.S. and UK, we have definitely been asked to provide proposals for Intensive Care at Home, which we are happy to do because (A), people need to understand how it works. (B), whilst we can’t provide the physical presence as yet in the U.S. or in the UK, we can still provide you with proposals and then you can go to other service provider that may want to be happy to run with it. And we can still educate them online how we run the service.
Again, we are happy to partner, we are happy to share our intellectual property in how to set it up properly and make it safe for clients and for families and also make it safe for intensive care units so they know that we can keep clients at home predictably, and I think that’s what it comes down to. Clients need to be at home predictably.
So that hopefully gives everyone again a quick overview. And whilst I can keep talking, I now want to open up the floor to any questions, if there are any questions. And they can be on topic or they can be off topic. I know there are people here that have questions and you can type them into the chat pad or I’ll also give you the numbers that you can dial into the show and then we can discuss your questions live here on the show.
So if you’re in Australia, you can call 041 094 2230. That is again 041 094 2230.. If you’re in the U.S. you can dial 415 915 0090. That is again 415 915 0090. And if you are in the UK you can dial 0118 324 3018. That is again UK 0118 324 3018. And you can dial in live on the show.
Now Helene, you’ve got a question. You’re saying, is modern urine disease the same as UTI infection? Now Helene, I have to admit, I’ve never heard of modern urine. What does it say? Modern urine disease. I’ve never heard of that. I have no idea what that means. I really have not heard of that. Is that something that your mom was suffering from?
Okay, while I’m waiting, I also want to talk a little bit while I’m waiting for people to call in or type in any questions here, I just want to highlight a little bit more about the discharge process from ICU. If you want to go home from ICU, what does it look like? Obviously, we need to talk to the ICU directly, we need to set up the home. And you know, might think, “Oh, what does the home need to look like? Does it need to be remodeled? Does it need to be remodified?” There are some homes that may need to be remodified and remodeled or renovated, whichever way you want to look at it. By the same token, there are many homes that can be used as they are as long as a hospital bed fits in, as long as a hoist can be installed. You’d be surprised what’s possible.
Yes, you need a hospital bed, you need a hoist. That can be a ceiling hoist or it can be a portable hoist, a lifting machine, that’s a different term for a hoist. Ideally you have a shower commode, a toilet commode, all of that. But a lot more is possible than you think there is. It really comes down often to a can-do attitude rather than sort of modifying the full house. Way more is possible than you think there is.
Okay, I can just see that Traca, you have a question. Just give me a second. Traca, you’re saying, if we can get dad off the ventilator at the LTAC, can he safely recover at home? I would say that he can, Traca. Going home is so much easier without a ventilator. And I know that way because I know your dad’s situation, Traca, because we’ve spoken. I do believe that your dad can get off the ventilator and going home without a ventilator is so much easier. So when I say going home on a ventilator, I probably need to clarify here, one should go home on a ventilator once it’s proven beyond the shadow of a doubt that someone can’t come off the ventilator, which is sort of the case. Yet studies that I highlighted today, for example, someone with motor neurone disease, someone with a C1 and C2 spinal injury, they’re not coming off the ventilator. But in your dad’s case, Traca, I do believe you have reason to believe that he might be able to come off the ventilator.
So it really depends on a case-by-case situation, because you got to picture this. If you’re taking someone home on a ventilator to wean them off over the next two or three weeks, it can be done. But if you’re setting up home care for someone on a ventilator, it’s more of a long term, not a short term thing. And you got to weigh up what’s more feasible? Is it more feasible to keep your dad at the LTAC for another three, four weeks and then take him home once he’s off the ventilator? Or is it more feasible to take him home now on a ventilator, wean him off half the risk of him bouncing back and forth. So you got to weigh up the risks. And also, as much as we are in the home care business, setting up home care is not an overnight process. If someone comes to us and says, “Hey, we’ve got this ICU patient here that needs to go home, how quickly can you make it happen?”
And the answer to that question is, well (A), it depends on location, depends what we need to organize in terms of equipment, we need to have a look at the house and so forth. So there’s a number of steps that need to take place before someone can go home, and it’s often not an overnight process. Don’t get me wrong, we have pulled off 24 hours literally overnight in emergency situations. Just to give you one example, we had this young boy couple of years ago, just before COVID, that was looked after at home by his mom. And he was on BiPAP, and he had cerebral palsy, and then all of a sudden his mom died. It was a 13 or 14-year old boy and his mom died literally unexpectedly. His mom died and he was an orphan all of a sudden. So then we were asked at the time to look after this boy 24-hours a day at home in his own home.
And we pulled that off pretty quickly because we had to and it was sort of a very unusual situation, real emergency, otherwise this boy would’ve ended up in ICU. His mom did a great job of keeping him alive, but she was probably also tired by doing so. And we have been pulling off 24-hours just literally overnight, but very difficult. But it can be done. But it’s not sort of how we usually approach things. If we can plan and if we can look at, “Okay, can we hire a staff? Where’s the location?” That sort of gives you better understanding, Traca, I hope, in terms of what needs to happen before you take your dad home. And Traca if, God forbid, your dad can’t come off the ventilator, of course you should consider taking him home, and then maybe that’s a conversation we need to have.
Who would you approach in California? I said I do believe you could approach potentially Bayada. Have a look at Bayada’s website is bayada.com. It’s B-A-Y-A-D-A.com. I do know that in some states in the U.S., they might be providing some ventilation tracheostomy care at home. They’re nowhere near as specialized as we are, but I know they are doing it in some states in the U.S. It’s a very unique skill taking someone home from intensive care or from LTAC, providing that ventilation and tracheostomy care. It’s a very unique skill. And we need to have people that know what they’re doing because again, it comes down to the predictability of the service. You don’t want to be taking someone home and then they keep bouncing back to ICU or back to hospital. That’s not how you want to approach home care. It needs to be safe, it needs to be predictable.
As I mentioned to you in the beginning, my first case study was… That our first client here in Melbourne was a young man who more or less lived in ICU because he couldn’t be looked after by his family or the support he had at home was inadequate because he didn’t have ICU nurses, and they simply couldn’t keep him home. So, you got to look at the infrastructure, and the infrastructure matters greatly in order to keep our clients and your dad home safely.
Okay, now again, are there any other questions? Do you want me to repeat the phone numbers again? Again Australia, if you want to dial in 041 094 2230. US, 415 915 0090, and UK 0118 324 3018. Or you can type your questions into the chat pad and I will get to them.
Yes, last but not least, in terms of case studies, home TPN also a growing demand. Again, patients in hospitals in ICU that get TPN (Total Parenteral Nutrition) also known as intravenous nutrition. People need to have a central line, a PICC line, or a Hickman’s line in order to have TPN. Central line, PICC line or Hickman’s line needs to be accessed, generally speaking by a highly skilled nurse, generally speaking by an intensive care nurse because the line needs to be patent at all times.
There’s the risk of line infection, dressings need to be changed regularly and that needs to be done with sterile technique. Often the lines need to be heplocked with anticoagulation so that they don’t block. Again, skill of an intensive care nurse. With some of our clients for home TPN, we just do the hook on and hook offs, which basically means one of our nurses goes there, connects the TPN, starts it with a client, and then disconnects it the next day, depending on how long the TPN is running for. And it also depends a little bit on whether the clients can manage any air alarms. Some of our clients can, some of our clients can’t, and if they can’t manage any air alarms with the infusion machine, we need to be there for as long as the TPN is running.
So why do people have TPN? There’s a number of reasons why people might have TPN. Gastroparesis is one of them. Digestive issues one of them. Rectal surgery or Whipple procedures, gastrectomies. There could be a number of reasons why people need TPN. Generally speaking with TPN, again, patients stay in hospital for a long time and we have many inquiries where people have been in hospitals for months on end with TPN, and the hospitals are telling them, “Well, you need to stay in hospital because you can’t have TPN at home.” Well, I can assure you, nothing could be further from the truth. Again, you should be contacting us whether we can help you with home TPN. And again, most of it is funded by the NDIS here in Australia. I hope that helps. I assume there are no other questions at this particular point in time. If there are no other questions, I want to wrap this up.
I will do another YouTube live stream next week, same time at 10:30 AM Sunday, Sydney, Melbourne time, Brisbane time, Sunday the 28th of August. That’s 8:30 PM Eastern Standard Time in the U.S., Saturday night. That’s next Saturday. I believe the topic next Saturday is how long can you leave at home on BiPAP, CPAP or VPAP ventilation? And again, I will dig a little bit deeper there on how long we can safely look after someone at home on BiPAP or CPAP.
Thank you so much for watching. Thank you so much for your questions and for your attendance.
Now, if you have a loved one in intensive care and you thinking of Intensive Care at Home, go to intensivecareathome.com and contact us on one of the numbers on the top of our website. If you have a loved one at home already with a ventilator, with a tracheostomy and you don’t have enough help, you have the inappropriate help with maybe support workers or no help at all, or you have general registered nurses who can’t really look after someone on a ventilator, you should contact us as well. If you have funding issues, you should contact us, we can help you with all of it.
Now, if you have a loved one in intensive care and you need help while you are in intensive care, you should contact us or you should go to intensivecarehotline.com, where we have a consulting and advocacy service for families in intensive care. You can contact us again on one of the numbers on the top of our website or send us an email to [email protected]. I would appreciate if you give this video a like, if you subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home. Share the video with your friends and families. Click the notification bell and I hope you have a good Saturday evening, good weekend, wonderful Sunday, and I will talk to you next week.
Thank you so much for your support. Take care.
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.
Intensive care at home Case studies
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.
www.intensivecareathome.com/careers
So we are also an NDIS, 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.