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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,
I CAN NO LONGER TAKE CARE OF MY SON AT HOME IF HE GETS A TRACHEOSTOMY AND VENTILATOR! HELP!
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
My Husband Has a Tracheostomy, Can He Be Decannulated?
Patrik: Hi Keno! How are you and how’s your wife?
Keno: I’m doing okay. How are you too, Patrik? Well, my wife’s been able to breathe fine, not losing her oxygen and stuff and be fine, but they didn’t want to remove the tracheostomy because she had a surgery coming up, but she’s done with it now, and she’s had the tracheostomy for almost two years. And I know she doesn’t want to live the rest of her life with a tracheostomy.
Patrik: Of course.
Keno: That’s my issue, basically.
Patrik: Of course. Okay. So, why did she have the tracheostomy in the first place?
Keno: Because she was hit by a car in March, almost two years ago.
Patrik: Yeah, yeah, yeah. Okay.
Keno: And she had a traumatic brain injury and stuff.
Patrik: Right. Okay. Sure. And with the traumatic brain injury, what’s the situation? Is she back to normal? Is she still impacted by it?
Keno: No, but she does understand me, and she does swallow.
Patrik: Right.
Keno: She meets all the criteria to be decannulated, but it’s just the fact that when she was in a nursing home, they wouldn’t take her to a doctor.
Patrik: I see.
Keno: I literally had to force them to do anything.
Patrik: I see.
Keno: They wouldn’t even try to remove it.
Patrik: Right. Does she have a surgical tracheostomy or a percutaneous tracheostomy, do you know?
Keno: It’s not a permanent one. It’s one that comes out. I forget which.
Patrik: No, no, I get that. My question is about when they did the tracheostomy way back when, did a surgeon do it, or did they do it in ICU with a percutaneous tracheostomy? Do you know?
Keno: I don’t know.
Patrik: That’s okay.
Keno: I’m pretty sure that they did it surgically. And I know it’s just a cuffless tracheostomy, but I don’t know exactly.
Patrik: It’s a cuffless tracheostomy. Okay.
Keno: Yeah.
Patrik: Just before we go on, Keno, I always have about 15 minutes of my free time, but my free time is obviously very limited. Beyond the free 15 minutes, I do have paid consulting and advocacy option.
Keno: Okay.
Patrik: Keno, what do you think is stopping her from having the tracheostomy removed?
Keno: Honestly, her issue is when they cap her off, she meets the four hours, they said. She would have it out all night. But the doctor don’t seem to understand that … She has a really strong cough. She can cough up secretions. But when they cap her off, because that balloon’s there and because the tracheostomy tube is in her throat, she can’t cough the secretions out of her lungs.
Patrik: I see.
Keno: I mean because it blocks it. They don’t seem to understand that. So, when they cap her off for 24 hours, she’ll build up secretions in her tracheostomy and she can’t cough it out.
Patrik: I see.
Keno: So, they’re acting like that she can’t maintain it because of that, and I’m like, “I disagree.”
Patrik: Yeah, sure. Do you suction her?
Keno: She can pretty much do it all on her own.
Patrik: I see. I see.
Keno: The only time I have to suction her is if she coughs up a bunch. She can cough it out herself, but sometimes it gets really, really thick and then I suction her. But other than that, she doesn’t need suctioned.
Patrik: I see. So, when you say she’s doing it by herself, you mean she’s coughing it up, she’s not using the suction machine herself?
Keno: No.
Patrik: Okay, great. What is the size of the tracheostomy tube?
Keno: She had a four, but she got COVID and it ended up going back up to a six. Because she had a six and it got lowered because she was trying to get rid of the tracheostomy. But then the ventilator that they put her on when she got COVID made it to where it was making the machine malfunction because her stoma is larger than it should be.
Patrik: Yeah.
Keno: And so therefore, the air was getting through all around the tracheostomy and making the machine malfunction.
Patrik: Yeah. I see.
Keno: So, they had to put it back up to a six.
Patrik: Okay. Does she have an inner tube? You know what I mean by that?
Keno: What’s that? No. Basically it’s about six inches long or whatever, and that’s it. There’s nothing else to it besides that and the balloon.
Patrik: There’s no inner tube that you’re changing regularly?
Keno: Oh yeah, the inner cannula?
Patrik: Yes, the inner cannula.
Keno: Yes, she does.
Patrik: Okay, she does. How often do you change that?
Keno: Every day.
Patrik: Once a day?
Keno: Yes.
Patrik: Okay. Is it very soiled when you change it?
Keno: Nope.
Patrik: Okay. Great. Okay. So, you said it’s cuffless and is it fenestrated?
Keno: What’s that?
Patrik: So, some tracheostomies have holes in the shaft.
Keno: Not that I’ve noticed.
Patrik: Yeah, you would know. Yeah. No, there’s no holes.
Keno: I’ve never noticed there was holes in the shaft.
Patrik: Yeah, okay. Good. She’s not on oxygen?
Keno: She’s on three liters. She wasn’t on oxygen until she got COVID.
Patrik: I see. She’s still on oxygen as of right now?
Keno: Through a mask that goes over her tracheostomy, yes.
Patrik: Yeah, okay. Humidified oxygen? On the humidifier?
Keno: What’s that? It’s just the regular oxygen.
Patrik: Okay. So it’s dry oxygen, not humidified?
Keno: Yeah, it’s dry oxygen. Yes.
Patrik: Okay.
Keno: I have a humidifier, but she doesn’t need it unless her secretions get really thick and then she’ll use that for a couple minutes just to thin them out.
Patrik: Right. Okay. What happens if you take the oxygen off, her oxygen drops, her saturation drops?
Keno: Not drastically, no. It’s just that we just leave it on just for safety purposes, because I have her home now.
Patrik: Yeah. Okay. Do you use regular nebulizers, like saline nebulizers, Ventolin, Salbutamol, any of that?
Keno: Nope. She has one. If she has any complications, she has one, but I’ve never used it.
Patrik: Okay.
Keno: They’ve only used it like one time even when she was in the nursing home.
Patrik: Yeah. Okay. Can your wife eat and drink?
Keno: No, she does not. But they’ve never tried. That’s the issue.
Patrik: Never tried. Yeah, yeah, sure.
Keno: They’ve literally never tried anything with her. They’ve left her lay there in bed.
Patrik: And she’s got a PEG (Percutaneous Endoscopic Gastrostomy) tube?
Keno: Yep.
Patrik: Right. Okay.
Keno: But she does swallow. I do know she swallows. I’ve watched her do it. I can hear it.
Patrik: Okay. Okay. So, when you say your wife rips out the tracheostomy, you put it back in?
Keno: They did. They were going to leave it out at the time when she was in the nursing home, but they reinserted it because she had a surgery coming up.
Patrik: Yeah, okay.
Keno: But now she’s done with it.
Patrik: Yeah. Okay, great. Okay. Keno, I’ll tell you what I think needs to happen here. I can’t tell you whether the tracheostomy can be removed or not, but I can tell you how you can find out. You should be talking to a speech pathologist or speech therapist as a next step. They should be doing a swallowing assessment with her. And if the swallowing assessment is clear, I do have reason to believe that the tracheostomy can be removed. But you got to do that test first.
Patrik: Have you ever spoken to a speech therapist, speech pathologist?
Keno: They did one time. They did a swallow test. She swallowed, but it was kind of hard for her because it does hurt her when she swallows, and I can tell it does. So, she doesn’t like to do it. But she can swallow. I do know that.
Patrik: Sure, sure. But you need to verify that with a speech therapist.
Keno: Okay.
Patrik: If they can verify, then I think you have reason to believe that the tracheostomy can be removed. But if you take it out and if it’s not 100% verified that she can swallow, she could end up with an aspiration pneumonia, and then she’ll end up back in ICU again. You don’t want that.
Keno: Okay.
Patrik: That would be my advice.
Keno: Yeah, no, because the nursing home has laid her flat before.
Patrik: Oh, that’s terrible.
Keno: And she aspirated just because of the feed tube so I know that.
Patrik: Yeah.
Keno: I knew that. Okay. Thank you, though. I appreciate your help.
Patrik: It’s a great pleasure. Please do that and see what they say. And just one more comment about the PEG (Percutaneous Endoscopic Gastrostomy) tube. I mean, you can’t change it now, but we strongly advise when patients are in ICU and have a tracheostomy, I mean, it’s too late now, we strongly advise not to give consent to a PEG. A simple reason, once patients have a PEG, nobody will try to feed a patient ever again because there’s the perception of a permanency with a PEG tube.
Keno: I agree. I want her to be off all of them, so therefore I’m trying to do it all, because it’s just the fact that the nursing home only wanted to maintain her, and they wouldn’t even work with us.
Patrik: Of course. Of course.
Keno: So, that’s why I was trying so hard to get her out of there.
Patrik: Of course. I’m all with you. I’m all with you. Once she’s got the tracheostomy removed and she can swallow, maybe then you can start working on getting the PEG removed.
Keno: Yep. That’s what I’m going to try and do.
Patrik: Yeah.
Keno: Thank you.
Patrik: It’s a great pleasure. All the best, Keno. All the best.
Keno: Thank you. Have a good day.
Patrik: Thank you. Same to you. Thank you. Bye. Bye.
Keno: All right. Bye.
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.