Podcast: Play in new window | Download
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,
CAN I HAVE ICU NURSES AT HOME FOR MY VENTILATED SON INSTEAD OF SUPPORT WORKER?
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.
My Mother is Having Trouble Being Weaned Off the Vent/ Tracheostomy with COPD in ICU, Can She go Home?
Hello. Good morning, good afternoon, good evening, wherever you are. Helene, nice to see you again. I hope you’re well. And I know there’s some questions I have prepared already today, and I will also dial Emma in, once we’ve gone through today’s question. I don’t know whether Emma’s here yet or not, but we’ve got some questions ready to go.
So, today’s topic is, “My mother is having trouble being weaned off from the ventilator tracheostomy with COPD (Chronic obstructive pulmonary disease) in ICU. Can she go home?” So that’ll be the topic today. Now, before we go into today’s topic, I also want to welcome our viewers that watch this in the recording, so thank you for watching it in the recording.
So, before we go into today’s topic, just a couple of things. If you’re watching this and you’re wondering what makes me qualified to talk about today’s topic, I am a critical care/ ICU nurse and I have been working in ICU/ critical care for over 20 years in three different countries. I have also worked as a nurse unit manager for over five years in my ICU nursing career in hospitals. I have been consulting and advocating for families in intensive care all over the world for the last 10 years as part of my intensivecarehotline.com consulting and advocacy service.
I’m also the founder and managing director of Intensive Care at Home where we currently are sending ICU and pediatric ICU nurses into the home for predominantly long-term ventilated adults and children with tracheostomies, but also for patients that require non-invasive ventilation, such as BiPAP or CPAP, and we also provide home TPN (Total Parenteral Nutrition).
So, with today’s question in particular, this is obviously right at the intersection of ICU, hospital ICU, as well as Intensive Care at Home. With Intensive Care at Home in particular, we are currently operating all around Australia, in all major capital cities, including regional and rural areas. We are also in the process of branching out into the United States with Intensive Care at Home. We now have a clinical liaison nurse in the U.S., Tara Thorpe is her name, and I will actually publish an interview or a podcast with Tara in the next couple of weeks. Please watch out for it on our intensivecareathome.com website and you’ll get to know Tara who used to work for us here in Melbourne, Australia for Intensive Care at Home. She’s actually a U.S. citizen, but she used to work for us here in Australia for a while. She’s a great resource for our clients in the U.S. Also, Saed, nice to see you here. Thank you for your kind words, and I’m sure I’ll catch up with you next week, Saed. I’ll reach out to you again.
Okay, let’s dive into today’s topic. “My mother is having trouble being weaned off the ventilator and tracheostomy with COPD in ICU. Can she go home?”
And again, after having worked in ICU for over 20 years, and also after having worked with Intensive Care at Home for over 10 years, probably for nearly 15 years now, including my time when I worked with Intensive Care at Home in Germany, the short answer to this question is a yes. So, if your mother’s having trouble being weaned off the ventilator and tracheostomy with COPD in ICU, can you go home?
The short answer is a yes, and one of the inhibitors in ICU of being weaned off the ventilator is simply that it’s not a conducive environment. Anyone that’s set a foot into an ICU knows there’s no quality of life, especially for long-term patients. If someone goes into ICU for a couple of days after having surgery or, God forbid, having a heart attack or whatever and they can leave ICU within a couple of days, that’s great. Recovery can take place in other areas, but long-term ICU is, (A) it’s not fun. Well, I mean there’s no day and night rhythm in ICU. The lights are on 24 hours a day, people are talking 24 hours a day, patients can’t really sleep at night, and getting back into a regular day and night rhythm is one of those things that is much easier to be achieved at home.
And also, at home you can create your own routine. You can create almost like your own care plan that works for you. And under the guidance of our nurses, we can still move you towards weaning off the ventilator, and you’re surrounded by your family. You are in the comfort of your own home. And in this day and age with having doctors on the other end of the phone with telehealth, there’s no longer any need to stay in ICU long term. Those weaning processes can take place at home. And you might say, “Well, but what about how do you take arterial blood gases at home?” And that can all be done now with capillary blood gas machines that they’re using also in emergency departments and emergency rooms. So, there’s no longer any need to have… You can have all the technology and all the equipment at home instead of an ICU.
Also, in an ICU, for example, you have different people every day. What I mean by that is the turnover of the staff in ICU is reasonably high, and getting regular staff to look after your mom is very difficult. Whereas we have teams that we created that we can send to our clients at home. And because they’ve got the ICU and the home care experience, we understand how critical it is to have the same people over and over again at home, so that you feel like you almost have your “friends” looking after you. And that’s a little bit of an exaggeration. We are health professionals at the end of the day, but getting that regularity and that regular team looking after someone and getting to know them, getting to know their preferences, understanding their preferences, and tailoring the nursing care around those preferences can make all the difference.
So, what does weaning look like at home? Let me run through the nuts and bolts, so to speak, what weaning looks like at home. So, you haven’t shared actually what ventilator settings your mom is on, but most COPD patients might start out with an SIMV (Synchronized Intermittent Mandatory Ventilation) or a controlled CMV (Continuous mandatory ventilation) mode in a hospital, maybe 15, 20 mandatory breaths per minute from the machine with a set volume. And then you’re trying to reduce that rate and see whether someone can breathe up, whether their blood gases are within normal range. You’ve got to monitor that patients are not getting exhausted. I would hope that your mom has gone through all of that in terms of weaning the ventilator to a minimum. You haven’t given too many details about what ventilator settings she’s on, but because I’ve seen it over and over again, let’s just run a hypothetical. But also real world examples, because again, I’ve seen it many times.
Once someone is weaned off an SIMV rate, at least during the daytime and they’re breathing in pressure support or CPAP mode, maybe with a PEEP of five, with a pressure support of 16, if the volumes are fine and tidal volumes, the volumes that someone on a ventilator is breathing should be between seven to 10 ml per kilo. So, for simplicity, if your mom is 70 kilos and she’s breathing 500 to 700 mils per breath and she’s not getting exhausted, she’s got a nice physiological breathing rate, let’s just say 15 to 30 breaths per minute, she’s not getting exhausted. Her tidal volumes are fine, she’s sitting up, she’s looking comfortable, she’s not getting sweaty, she’s not feeling short of breath. Then it comes down to what does the arterial blood gas show? Is her CO2 (carbon dioxide) within a normal range, which for COPD patients is obviously one of the most important parameters to look for.
And if that is all within normal range, then the next step might be to take your mom off the ventilator for a little while, take her off the ventilator maybe for 10 minutes with a tracheostomy mask or a tracheostomy shield, give her some humidified oxygen. And also, before you can take your mom off the ventilator, obviously her oxygen levels need to be below 40% FiO2. By the same token, the oxygen level is probably not so much the issue for someone with COPD. It’s often the CO2 level that is more important with patients for COPD. So, what else needs to happen before your mom can go home? Obviously, we need to get a good handover from the ICU. We need to understand the ins and outs of your mom’s medical history. We need to understand what has worked so far and what hasn’t worked.
And again, one of the issues in ICU for long-term weaning is there’s a huge psychological component that when you take a long-term ventilated patient off the ventilator, they might be able to cope, but they feel like they’re almost not able to cope without the ventilator, because maybe they’ve had an experience in the past where even in the early stages of their ICU admission, maybe they got disconnected from the ventilator while the nurses were turning your mom and they were washing her back and for whatever reason she became disconnected from the ventilator. And it might only have taken a few seconds to get her back on that ventilator, but still that can be a traumatic experience. And just with those experiences in mind, there could be a huge psychological component. There could even be some trauma that was done just by having her disconnected from the ventilator for a few seconds, her feeling suffocated, and now she’s at the point where she feels like, “Well, I need that ventilator no matter what.” But that’s not necessarily accurate. There needs to be a lot of handholding to be done, quite literally, in situations like that where patients are being weaned off the ventilator.
Now, other things that need to happen, I’m assuming your mom is in a position to be mobilized, she needs to get out of bed. When someone has been in a prolonged induced coma, the deconditioning of the body is real, and it happens very fast. And that includes the respiratory muscles. So, if someone needs to be weaned off the ventilator, they need to get mobilized so their upper body can strengthen their muscles, and that includes the breathing muscles and the diaphragm. Only then is weaning off the ventilator possible.
So, what else needs to happen? Other things that need to happen is obviously good basic nursing care, which means regular bed baths, showers, mouth care, eye care, washing the back, preventing pressure sores, preventing deep vein thrombosis through massage, through physical therapy. Very, very important. And also, the mobilization part.
For someone on a ventilator, it’s also important to prevent ventilator-associated pneumonia. Most patients on ventilation are at risk of getting another ventilator-associated pneumonia, and that risk is even higher in ICU as opposed to a home care environment, and simply because of the hospital environment. So in a hospital in an ICU, you’ve got many, many sick patients, and doctors and nurses go from bed space to bed space. They carry all the bacteria with them when they go from bed space to bed space, so therefore the risk of an infection is much higher. Whereas at home, the risk of an infection is so much lower. But nevertheless, people need to get mobilized daily to prevent them from getting another ventilator-associated pneumonia. And thank you for your comment. “Weaning success depends on factors like support system, familiar environment, preventing delirium and exhaustion, non-depressant sedation, physiotherapy, and psychological support.” Absolutely, it’s huge, and that can probably be much better achieved in a home care environment than in an ICU.
A familiar environment is huge. If someone is in ICU, it’s definitely not a familiar environment. And whilst most ICUs I believe have a good support system, it can’t replace the support system that people can get at home with a service like ours. So that is my take on that. But I appreciate your input, Saed. And non-depressant sedation, one would hope that once a tracheostomy has been done, that sedation would be stopped immediately, assuming there are no other factors that require sedation. Yeah, home care with skilled nurses create this situation, absolutely. Creates that situation. Skilled nurses, but also a regular team, Saed. I’m sure from your experience, you would’ve also known that having a team that gets to know the patient is important, whereas in an ICU, you have different people all the time, and that creates that irregularity that could potentially set patients back. So thank you, Saed, for your input there.
Now, and then once your mother has time off the ventilator, again, maybe one day it’ll be 10 minutes and the next day hopefully it’ll be 20 minutes, and then it’ll be 30 minutes and so forth. It could be a slow process, it could be a quick process. We don’t know, you haven’t shared too much there about your mom. And then go from there. Now, next is I do want to call Emma. Emma has sent me a text earlier. She’s got a question. I’ll just see whether I can dial Emma in and get her question answered. Just give me a second, please. I’ll just dial Emma in. Hi, Emma, it’s Patrik here from-
Emma: Hello.
Patrik: Hi, Emma, it’s Patrik.
Emma: Hi, Patrik.
Patrik: How are you?
Emma: I’m great, how about yourself?
Patrik: Very good, thank you. Emma, are you okay if we go through your question?
Emma: Yes, please.
Patrik: Are you okay if I read it out?
Emma: Yeah, that’s fine.
Patrik: Okay. So what are some preventive measures we can take to prevent my dad from having another pneumonia or respiratory complications given that he recently got his tracheostomy tube removed and seems to be doing well with the swallowing of mashed foods and thickened drinks at the hospital? Now, Emma, before I move on, is he at home already?
Emma: No, he’s at a different hospital because where he had the trach done, I think they prematurely released him to a long-term facility. And in that facility he was there for three days, so he had to come back to a different hospital with pneumonia because of-
Patrik: Right.
Emma: … how they… Yeah, they didn’t put the proper type of oxygen. I forgot what they call it, but he was supposed to get moisture, not just dry air into his lungs, and that’s what caused the mucus.
Patrik: Right. How long ago was that?
Emma: That was like a week ago. He was admitted last Saturday to the hospital and he’s still there.
Patrik: And did they need to put the tracheostomy back in?
Emma: No, the doctor said it had already closed from the inside and a little bit was holding the, I forgot the thing, the trach inside, but it closed from the inside. He says we’re going to take it off and see how he does on his own. And he did well. He only has that cannula, I think it’s called, the little one in the nostril, the supplemental oxygen, but.
Patrik: I see.
Emma: But other than that, he’s breathing.
Patrik: So, he didn’t need any BIPAP (Bilevel positive airway pressure) or any CPAP (Continuous positive airway pressure), do you know what I mean by that?
Emma: CPAP? No, no. He has no procedure, and he’s starting to drink thickened water and pureed food. A little bit, like spoonfuls.
Patrik: Right, right. I see. Right. And now your next step is to look at home care.
Emma: I’m looking at that because they’re telling me he needs to go back to a facility, and I’m questioning them now, because in the facility where he got pneumonia again because of a lack of, how should I say this, them properly taking care of my dad.
Patrik: Yeah, I’m not surprised. I’m not surprised. We see this all the time where patients go from ICU to LTAC (long-term acute care) or a skilled nursing facility, I’m talking about the U.S. specifically here, and then they bounce back. Unfortunately, I’m so not surprised to hear what you are sharing there. And now have they cleared the pneumonia?
Emma: They say that his labs are looking good, the blood count, everything. But they won’t tell me that his pneumonia is clear. He still has more days left on the antibiotic.
Patrik: Have they done a chest x-ray?
Emma: Chest x-rays? Not that I’m aware in the last three days, they haven’t done a chest x-ray, but they did one initially.
Patrik: Right. I would argue, Emma, you may want to ask for a chest x-ray to see whether his pneumonia has cleared or not. Does he still have a temperature?
Emma: No more, no.
Patrik: Okay. Do you know whether his white cell count is still elevated? Do you know what I mean by that?
Emma: Decreased.
Patrik: Decreased, okay.
Emma: Yeah, and the nurse informed me this morning that his labs, his white blood is looking really good and she says I can tell the medication’s working, his labs are looking good. But I would have to go and get myself familiarized with all the different ways.
Patrik: Yeah, right.
Emma: The medical stuff.
Patrik: Right. And then you are also saying in your email, “Considering in-home medical care for my dad because of the inadequate level of care being given by the skilled nursing facilities. Would care providers at home be able to provide proper healthcare for my dad. TBI survivor, 70 years, not mobile with speech and vertigo issues.” Now, I would argue a good home care provider will be able to do that for you. You would need to start talking to some of them. It’s outside our area of expertise. Our area of expertise is more like the high acuity stuff at home, which means ventilation, tracheostomy. I do believe your dad going home should be much safer now with a good home care provider. You may not even need 24-hour nursing care. You got to talk to some home care providers that are specialized on the sort of general nursing care aspect, and you got to find out what their approach would be. Your dad, you’re saying, is not mobile, is that correct?
Emma: Yeah, he requires two persons to help. When they’re doing the physical therapy at the hospital, one is on the right, the other one’s on the left and helping him to do the therapy that way. That’s why he doesn’t qualify for the one they have in the hospital, because that one says only one person. And it’s three hours long, so it’s going to be too much for him.
Patrik: Right. And for home care, do you have lifting equipment, like a hoist, like a lifting machine? Do you have any of that?
Emma: I don’t.
Patrik: My recommendation here, Emma, is you’ve got to start talking to occupational therapists because it sounds to me like you will need that equipment going forward. And my advice is talk to either an occupational therapist in the hospital or outside of the hospital. Someone that’s familiar with setting up home care, because no matter who’s going to mobilize your dad going forward, without hoist or ceiling hoist or lifting machines, you or your family or the staff working with your dad would be at high risk of back injuries. You can’t risk that.
Emma: Right.
Patrik: It’s too heavy, it’s too risky. Also, the risk for your dad then having a fall because you mobilize him without any equipment, it’s too high.
Emma: Right. Okay.
Patrik: And especially you also talk with the vertigo issues that you are referring to, is this something that you think might subside? Is this temporary, or is this an ongoing issue?
Emma: It has subsided. It started for the very first time, or at least that we noticed, he started verbalizing, mumbling that, it was three days ago. They gave him something for that and then the following day, no complaints about vertigo. But I don’t know if the issue he has on the one side of the eye has to do with possibly because of the fall, the brain injury, or is it because of the vertigo?
Patrik: Right.
Emma: I don’t know.
Patrik: Right, okay. And what is the hospital telling you about going home? Is that something that is imminent?
Emma: The way that they’re describing it is he needs to go to skilled nursing. It doesn’t have to be acute anymore because he has no tracheostomy anymore. But skilled nursing, they don’t know for how long, until he’s strong enough to come back to the hospital to do their more advanced occupational therapy. And usually people that do occupational therapy they say at the hospital is anywhere from a couple of weeks, like two, three, four weeks, and then they’re able to go home.
Patrik: Right. If you could wave a magic wand and you could go home next week, would you do that? Do you think your dad is ready? If you had all the equipment and all the staff, do you think your dad is ready?
Emma: I think he will be much more happy at home surrounded by his family.
Patrik: Of course.
Emma: The only thing is I want to know that he’s going to be taken care of, whether it be a proper nursing staff or a therapist familiar with this type of injury.
Patrik: Yeah. As I said, from what you are sharing with me here, I do believe you will need to start talking to a general nursing service at home, like with what we do with Intensive Care at Home, it’s probably one step below because I don’t think you need an ICU nurse at home for the level of care that your dad needs, but you will need proper equipment because it’s got to be safe when you mobilize your dad. And as you appreciate by now, your dad probably will need to get mobilized to get him stronger again, would you-
Emma: Yeah, yeah, definitely.
Patrik: Is he getting mobilized at the moment?
Emma: Yeah, right now he’s getting about 30 to 40 minutes of therapy, speech therapy. Not so much speech. Right now it’s mostly the swallowing.
Patrik: Right, I see.
Emma: And then they’re going to start with the speech.
Patrik: Right. Right. Okay. And I wouldn’t know whether… you also have a question around… As I said, our service is not really the right service for this because we are more specialized on taking patients home from ICU with ventilation tracheostomies. So, to me it sounds to me like you might start talking to some general nursing services. The two services that I can recommend you to contact is one of them would be BAYADA. Start contacting-
Emma: How do you spell it?
Patrik: BAYADA, B-A-Y-A-D-A.
Emma: B-A-Y-A-D, like David, A?
Patrik: Yeah, like David, A. Have a look at their website, bayada.com. They have offices all around the U.S. And the other service that we know of that seems to have a good reputation is Maxim, M-A-X-I-M, Maxim Healthcare. They have offices all around the U.S. as well, and they seem to have a good reputation too.
Emma: Would you happen to know if any of this take Medicare?
Patrik: Oh, they take Medicare. They take Medicare. Have a look at their websites and have a look at… On their website, you can see what office you can call in California, I believe you’re in California?
Emma: Yes, I am.
Patrik: Right. So, I’m pretty sure on their website you can actually, when you go to locations, you can see they have offices in LA, San Francisco, San Diego, and all the major places in California. And then contact them there. And I’m also positive that if for whatever reason they can’t help you, that they can hopefully point you in the right direction.
Emma: Definitely, yeah. Yeah, most definitely. Going back to the pneumonia.
Patrik: Yep.
Emma: Once it’s cleared, are you able to see it on the x-ray that his lungs look more clear?
Patrik: Yep. Yep. Ask them to do a chest x-ray, and that chest x-ray will hopefully say that the pneumonia is clear. He’s still on IV antibiotics?
Emma: He’s still on antibiotics, and that’s why I’m… I don’t know, it’s been a week, maybe it’s for 10 days, maybe he has a few more days left.
Patrik: So even though the pneumonia might be cleared, he would still need to finish his course of antibiotics, if that makes sense.
Emma: Right. Yeah, that makes sense. Okay.
Patrik: Is he on IV, on intravenous antibiotics?
Emma: He’s on two kind. One is intravenous, and I think the other one they smash it and put it in the food.
Patrik: In the food?
Emma: What was it called? I wrote it here somewhere. Vancomycin.
Patrik: Vancomycin. Sure.
Emma: Yeah, that’s one of them.
Patrik: Right. They should also check some vancomycin levels if he’s on vancomycin. Ask them if they’re checking vancomycin levels.
Emma: To check that on the blood?
Patrik: Yeah.
Emma: Okay. Not to be too high?
Patrik: Say again.
Emma: For the vancomycin not to be too high?
Patrik: Yeah, well it should be within a certain range, because if it’s too high it can be toxic. If it’s too low, it doesn’t have the effect that it’s supposed to have.
Emma: Oh, does that depend from person to person what’s considered a good range?
Patrik: No, no. They have a standard range. I would have to Google it, what the standard range is.
Emma: Oh, gotcha.
Patrik: They should target the dose around his weight.
Emma: The weight, gotcha. But yeah, he has lost a lot of weight. Right.
Emma: Is there a vaccine for pneumonia?
Patrik: A vaccine? Not really. Not really, unless the pneumonia has been caused by COVID. You are aware that there’s COVID vaccines, but even the COVID vaccines don’t stop people from getting COVID. But there’s no vaccine to prevent. There’s supposedly flu shots that prevent people from getting a common cold, and getting a common cold and then develop into pneumonia. It looks like Emma has gone. All right, let’s see if Emma calls back. Saed, you had a question. How about checking ABGs (arterial blood gas) in the home for rising PCO2 (carbon dioxide)? Did you do this routinely? We don’t do it routinely, Saed, but we can do it. As I mentioned briefly, there are some machines out there where you can check a capillary blood gas at home, and even in EDs they are being used, those machines. So there are options out there to check ABGs at home, for sure.
Now, let’s go back to some of our other questions. There was also a question from Pharan. I just quickly need to look through my emails. Pharan had a question and asked, “How can a tracheostomy be removed? What needs to happen, and can it be done at home?” So generally speaking, in a nutshell, yes, it can be done at home. And how often do we check x-rays at home? It depends, right? We have had clients at home, Saed, where we have the suspicion that they might have a pneumonia or a chest x-ray, that’s when we would call for a mobile x-ray. But it’s not necessarily done routinely. Not necessarily done routinely. And quite frankly, whilst the home imaging company is great, they are a little bit slow with all the… I hope they’re not watching this. And there’s Emma calling back. Just bear with me. Sorry, Emma, we got disconnected.
Emma: Sorry. I got the worst service, I think.
Patrik: Right, right.
Emma: I’m sorry, go ahead.
Patrik: That’s okay. Where were we? We were on…
Emma: You were telling me that there’s some flu shots. Is that helpful?
Patrik: Yes, yes. Flu shots. Yeah. Look, I guess most health professionals would say that it’s helpful. It’s a flu shot. It doesn’t prevent pneumonia, but it should prevent someone from getting the flu that could develop into a pneumonia.
Emma: Into pneumonia, so complications.
Patrik: That’s right. Your dad hasn’t had the flu shot before winter?
Emma: It’s been a while because his health was so good he was managing with diet and exercise. But you know what? It’s a good idea now because it’s been at least three years since he had the flu shot.
Patrik: Right. And when he had the flu shot, he didn’t get sick.
Emma: He got sniffles. That’s why he kept on telling me, “I don’t want the flu shot because I’m going to get sick.” Just a little bit.
Patrik: Yeah, no, I get that. And that’s why a lot of people don’t want the flu shot because they get symptoms when they actually do get the flu shot. So yeah, it’s up to the individual on what they want.
Emma: Yeah, when they asked me if they should give him the shots, I was thinking he’s already in a fragile condition right now. Do I need to compromise? It’s like, ugh. It’s hard.
Patrik: It is. But since we spoke last time, Emma, your dad’s situation has improved significantly, even though we had a setback.
Emma: It has. Yeah, I got to be thankful for that because even though it was a complication from the nursing home not taking care of him, the silver lining is that he doesn’t have the tracheostomy anymore and he’s doing okay with the oxygen that he’s getting. It’s just a little bit supplemental oxygen he’s getting.
Patrik: Right. How much? Do you know how many liters?
Emma: I think it was 20 liters.
Patrik: Probably two. Not 20. Probably two.
Emma: Yeah, two. And it’s cannula, he’s getting the one in here in the nostrils, and sometimes he takes it off by mistake and he pulls things. And still, his oxygen is still good.
Patrik: Right. Okay. Right. Okay. You could use a little bit of oxygen at home if need be. However, the oxygen might simply be a result of him needing oxygen temporarily because of the pneumonia. I would hope that once the pneumonia has cleared that he won’t need any oxygen.
Emma: He can start getting weaned or a little bit at a time, see how he does on his own.
Patrik: Yeah. And make sure they keep mobilizing him. Would you say that the pneumonia happened because they potentially didn’t mobilize him?
Emma: That’s a big possibility, because they did not start any therapy on him, any physical therapy. And also, another thing is they were supposed use the oxygen with humidity and were simply using just dry air.
Patrik: Dry. It’s terrible. I’m shocked to hear it, but also not surprised. It seems like good nursing care is going out of the window everywhere. It’s terrible to hear that, because little things like that can make all the difference.
Emma: The difference, yeah.
Patrik: Can make all the difference.
Emma: I was surprised. And Patrik, my family, my siblings we’re all involved. We’re taking turns. Somebody’s always there. Now, we missed this because we’re not professionals in healthcare.
Patrik: Sure.
Emma: That’s why we missed it. Hey, there’s a respiratory therapist coming and administering this. So we are like, “Oh, okay, taken care of.” But then when he went to the hospital, the nurse brought my sister in and showed her this is what they should have been using. And she showed her it has to have a mister, and your dad did not have that. So we’re like… We kind of felt bad because we missed it. But at the same time, like you say, you don’t know, given the circumstances.
Patrik: Yeah. But look, now you have a better idea of what to look for, right?
Emma: Yeah.
Patrik: You have a much better idea of what to look for. I do believe your dad is probably fairly close to go home, but you will need all the equipment to make it safe for you for any provider you might potentially have coming into your home. And also for the staff that you can’t have staff going off sick because they sustain a back injury, or yourself or your family. That’s the last thing you need.
Emma: Yeah, for sure. I’m going to find out about… and I just remember there’s two kinds of services that he… Well, three. One is the nurse that has some medical knowledge and then there’s the other one where they do the cleaning.
Patrik: Yes, sure. More like a support worker type.
Emma: Yeah.
Patrik: Yeah, sure. You might need both.
Emma: And then a therapist.
Patrik: Yeah, you might need both.
Emma: Yeah, I think so. I think so. And then for during the day, and if anything, we probably can take turns at night to help with that. And then, oh, and the occupational. Oh, geez. And we have the speech therapist.
Patrik: Yep, speech therapy, potentially a dietitian, depending on how… If your dad can eat and drink, that’s great. That should be your ideal scenario. Then you may not need a dietitian, but if there’s issues still with swallowing and digestion, you might need to keep working with a dietitian and a speech therapist.
Emma: Yeah. It’s really hard to get a doctor to come to your home, though.
Patrik: Yes. What about your family doctor? Do you have a family doctor?
Emma: He used to have Kaiser, and I had to remove him from Kaiser because a number of long term facilities affiliated with Kaiser were very little. So I had to remove him. Now he has, what do they call it? Traditional Medicare. The good thing about it is I can go to different providers as long as they have traditional Medicare. So there’s more of a pool to work with.
Patrik: More of a pool.
Emma: Yeah. But so far I already called seven doctors in offices and they told me that, no, they will not visit the patient.
Patrik: Right. Right. Okay. Two suggestions here, Emma. There should be after hours services for that, and those after-hour services potentially do two things. Number one, they might send someone to your home. We use them all the time here in Australia, we have what’s called after hours GP services. GP stands for general practitioner, which is similar to a family doctor, really what you would be referring to, a family doctor. So if there are after hours GP services here, and they’re coming to people’s homes, the same would be available in the U.S. Have a look. There must be. That’s one option. The other option is virtual consultations like telehealth, right?
Emma: Yeah. So that works, unless they have to listen to your lungs.
Patrik; Yes. That could be one. But it could just be a physical assessment. Could just be a… Sorry, a visual assessment.
Emma: Oh.
Patrik: If you have a nurse at home, well, they should be the ones listening to your dad’s chest with a stethoscope and liaising with a doctor.
Emma: You’re right, you’re right. That’s true.
Patrik: So have a look at some of those options. Again, when we can’t liaise here with a GP, for example, we then escalate it to here, for example, there’s an organization called My Emergency Doctor, and you can get an emergency specialist, a doctor on the phone 24 hours a day.
Emma: Okay.
Patrik: Right? Well, there must be… I believe actually, as a matter of fact, the US is much more developed than we are here in terms of telehealth, after hour services. I do believe it’s more dynamic than here even.
Emma: I just probably don’t know what to look for.
Patrik: That’s right. You don’t know what to look for yet. That’s all. So keep looking for those services.
Emma: Okay.
Patrik: There could also be services, like you might get a nurse on call. If you have a nurse at home, they should be the ones doing the liaising with the doctors. Right?
Emma: Yeah.
Patrik: For times-
Emma: Unless something happens after hours at night, then I guess I’ll have to call.
Patrik: But your dad will also be most vulnerable at night.
Emma: True. Because of the lungs?
Patrik: Because of the lungs, but also because he’s immobile. He needs to be turned regularly. So if no one’s turning him regularly, he’ll end up with a pressure sore.
Emma: Yeah. We need to be trained on that. Is there something that-
Patrik: You need to be… Again, I would argue a good home care nursing service slash agency should be able to train you on that.
Emma: Home care. Would you say home care, nursing service?
Patrik: Yeah, the ones that I mentioned to you, like BAYADA or Maxim. And they are big providers, don’t get me wrong. They’re very big providers, but you may also find smaller providers in your area that I have no idea about that might be able to help you with that.
Emma: Yeah, I just need to tell them it’s skilled nursing, I think is a term they used, skilled nursing. Because one I called and she said that she only provided the hygiene portion of that, but I will definitely take a look at this. B like boy, A like apple, Y like yellow, A like apple, D like David?
Patrik: Yep.
Emma: A like apple?
Patrik: Yep, dot com. Have a look at that website. bayada.com.
Emma: That’s a start.
Patrik: That is a start. And the other one is Maxim Healthcare.
Emma: Okay, got it. Oh, yeah, I think I’ll be able to breathe more if I could have somebody that knows what they’re doing and for him to be at home.
Patrik: Absolutely.
Emma: Because right now we can’t let our guard down with this type of care.
Patrik: Right. But look at the positives. As I said, since we last spoke, Emma, your dad has come a long way.
Emma: Yes. True. I need to look at that too.
Patrik: Yeah, look at the positives. And now it’s a matter of taking him home safely so that he doesn’t bounce back into ICU.
Emma: Yeah.
Patrik: Or into hospital.
Emma: Just even the best of those facilities still, they dropped the ball, and I think it’s the whole system in the U.S.
Patrik: The system here is not that great either. It all comes down to finding the right organizations and the right individuals. Healthcare is-
Emma: Thank you.
Patrik: It’s a great pleasure. It’s a great pleasure. Healthcare is challenging at the best of times.
Emma: It is. It’s challenging even when you just get admitted because of a flu. Now imagine somebody with traumatic brain injuries. Wow. Yeah, never. Nothing would prepare me for this. Our family, thank God, has relatively been pretty good, pretty healthy until this accident has happened.
Patrik: Yeah.
Emma: Life is precious. It just makes you appreciate it even more. I so much appreciate what you do, what you give. And that also has opened my eyes to possibilities, because I recently got my degree in social work and I was like, “You know what? I think you develop a passion to help other people.” If you can help one person not go through all this pain, why not?
Patrik: Yeah. Absolutely. Absolutely. There’s a lot more possible than you think there is. But yeah, you’ve got to look for resources and you’ve got to be creative. If you follow what the system is trying to dictate you, you’re doomed.
Emma: Yeah. That’s how it feels. And I’m sure that’s how so many people out there, their loved one is starting to recuperate and then they don’t get the necessary care, and back to square one.
Patrik: Yeah.
Emma: Yeah, for sure. All right, this is definitely a good start. I will go ahead and locate this information, and hopefully I have good news to report to you.
Patrik: Absolutely. Absolutely. Looking forward to hear from you again, Emma.
Emma: Okay, thank you.
Patrik: Thank you. Thank you so much. All the best. All the best. Thank you. Bye.
Emma: Bye.
Okay, so that was Emma. I do want to get to a question from Pharan. Pharan emailed me before this call. He says, “My wife has a complex brain injury with hypoxic brain injury for the last six months. She’s now got a PEG (Percutaneous Endoscopic Gastrostomy) and a tracheostomy tube attach and she’s very weak. Question is, how we can assess the tracheostomy tube, will it be able to be removed?”
Now, Pharan, there is an article on our intensivecareathome.com website “When the tracheostomy can be removed?” I urge you to look at that article. In the meantime, I argue that if your wife has a hypoxic brain injury, I don’t know to what extent, I don’t know what her Glasgow Coma scale is like. I don’t know whether she can swallow in particular. With hypoxic brain injury, a lot of patients can’t swallow. And if she can’t swallow and if she doesn’t have a tracheostomy, the risk of her ending up with an aspiration pneumonia is real, right? Therefore, it’s unlikely that the tracheostomy can be removed.
But again, I don’t know the extent of your wife’s hypoxic brain injury. And I urge you to check out the article on our website. I will try and put the link to the article below this video. Okay, Helene, you’ve had a comment. Atlanta Medical ICU pulmonologist lied to me that my mom had COPD lung cancer and needed to be transferred for emergency surgery. That was not true. She was given allergic antibiotics via versus X pack. So, I presume she did have surgery in the end, and I know you’ve done your own research there, Helene, you’ve looked at the medical records of your mom so you would know all the ins and outs.
Now I am going to wrap this up for today. We are very close to the hour mark. That was a very interactive session today. Thanks for all your contributions from Helene, Saed, and also from Emma, and also from Pharan. Thank you for all your contributions and your questions, and thank you for your support.
I’m going to wrap this up for today.
I will do another YouTube Live next Sunday, 10:30 AM Sydney Melbourne Time, which is Saturday night, 8:30 PM Eastern Standard Time, 5:30 PM Pacific Time. It is 1:30, no, half an hour past midnight in the UK when I do those YouTube Lives. Please look out this week when we announced it, we got the times wrong in the US, so it is 8:30 PM Eastern Standard Time on a Saturday night, which is 5:30 PM Pacific Time in the U.S. So, looking forward to meet you all again next week. Same time, same place.
Now, if you have a loved one in intensive care, go to intensivecarehotline.com, call us on one of the numbers on the top of our website, or simply send us an email to [email protected] with your 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 in a membership area and via email. And we answer all questions intensive care and Intensive Care at Home related.
If you need a medical record review, please contact us as well. We review medical records for families in ICU in real time, but also after intensive care if you need an NDIS nursing assessment, if you are in Australia, we do NDIS nursing assessments as well, and we can provide NDIS specialist support coordination predominantly for long-term ventilated adults and children with tracheostomies, non-invasively ventilated clients on BiPAP, CPAP, seizure management at home, as well as home TPN. And again, we provide the assessments for that as well, and the NDA support coordination.
Now, if you like the video, if you find value in it, click the like button, click the notification bell, subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home, and comment below what questions and insights you have, what topic you want me to make a video about or a YouTube Live, and we’ll go from there. Have a great day, have a great evening. Thanks for watching.
This is Patrik Hutzel from Intensive Care Hotline and Intensive Care at Home, and I’ll talk to you soon. 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.