Hi, it’s Patrik Hutzel from Intensive Care at Home, where we provide tailor-made solutions for long-term, ventilated adults and children with tracheostomies. And where we also provide tailor-made solutions for hospitals and intensive care units, whilst providing quality services for long-term ventilated patients and medically complex patients at home including Home TPN (Total Parenteral Nutrition), Home BiPAP (bilevel positive airway pressure), Home CPAP (continuous positive airway pressure), IV potassium and IV magnesium infusions as well as home IV antibiotics. So we cover the whole range that’s available for patients in intensive care. We can do that at home.
So in today’s blog, I want to answer a question from a reader, “Should a tracheostomy cuff be inflated for CPAP mode for a client at home?” The short answer is absolutely yes.
There are exceptions to the rule. The exceptions are for pediatrics or kids, because they, generally speaking, don’t have cuffed tracheostomy tubes. But for adults, the tracheostomy cuff for CPAP mode should be up because, otherwise, it’s just leaking and the PEEP (Positive End-Expiratory Pressure) won’t be delivered, which defeats the purpose.
More importantly, by not having the cuff up. There’s also a risk for aspiration and then your client ending up with an aspiration pneumonia. So, even with a cuff up, there is a risk for micro aspirations, but it’s much, much lower with the cuff being up.
Again, there’s one exception that I’ve seen over the years, where the cuff isn’t going up for adult patients with CPAP or with ventilation at home, the exception is if there’s a risk for pressure sores in the back of the throat in the trachea, but that’s a very rare exception.
I’ve never really seen it over many years with but one client in out of hundreds of clients, whether it’s in ICU or at home. So, but it also tells me that the person who’s asking this question probably doesn’t have a professional service at home because when you look at our website at intensivecareathome.com, you will be seeing a section there, the Mechanical Home Ventilation Guidelines.
When you look at the mechanical home ventilation guidelines, which are a result of 25 years of Intensive Care at Home in Germany and more than 10 years of Intensive Care at Home in Australia. The evidence-based mechanical home ventilation guidelines demand that only critical care nurses with a minimum of two years of critical care nursing experience can look after ventilated and tracheostomy patients at home. Anything else is not safe, even deadly.
It’s telling me that whoever is looking after this patient with CPAP and tracheostomy at home doesn’t really know what they’re talking about because otherwise, this question wouldn’t even come up because the CCRN (Critical Care Registered Nurse) would know that. And they would never have the cuff down.
I wouldn’t be surprised if this particular client is going back to ICU all the time and is not looked after properly at home and therefore, is at very high risk of either dying or going back into hospital case in point.
You might have heard me mentioning this before here on my channel, that some clients at home with ventilation and tracheostomy even without ventilation, but with tracheostomy have died because they weren’t looked after with critical care nurses 24 hours a day and they passed away at home when critical care nurses weren’t around, even though it’s evidence-based and needed to have them 24 hours a day. They died because family members or support workers or even general registered nurses without intensive care nursing experience couldn’t manage medical emergencies and patients died.
So that just goes to show how important it is that only third party accredited and evidence-based services can replace an intensive care bed at home in the community and replicate the ICU in the home, in the community. It has to be evidence-based and it has to be by third party accredited healthcare services like we are.
We are the only service as of 2023 in Australia that has achieved third-party and government accreditation for Intensive Care at Home nursing services. That includes NDIS (National Disability Insurance Scheme). And if you are a NDIS support coordinator in particular, and you have a client and or an NDIS participant who needs ventilation, tracheostomy and you don’t know what to do. You don’t know what funding is needed well, you need 24-hour nursing care for this particular client with critical care nurses. Otherwise it could be a death sentence. So I urge you to reach out to us, we can help you with the advocacy. Otherwise we wouldn’t be in business.
If you are a patient or a family member having a loved one long-term in intensive care or on a respiratory ward with ventilation, tracheostomy, if you want to go home, please contact us. Once again, we can help you with the funding. We can help you with NDIS support coordination or we can help you with the funding with any other funding bodies such as the TAC (Transport Accident Commission) in Victoria, ICare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), and the DVA (Department of Veteran Affairs), please talk to us. We can help you with the funding side of things.
Now, and if you are a CCRN and you’re looking for new career opportunities, we currently have new career opportunities in Sydney, Melbourne and Brisbane. So please contact us if you are a CCRN with a minimum of two years CCRN experience in a hospital.
If you are an intensive care specialist, we want to hear from you as well. We are currently expanding our medical team as well. And share your thoughts on this video, what questions you have or if you’re a hospital executive watching this and you have ICU bed blocks, even emergency department bed blocks, we can help you manage your ICU and emergency department bed blocks.
We’re currently also providing an emergency bypass service for the Western Sydney local area health district. So we’re sending our CCRNS into people’s homes and sometimes into residential aged care facilities and provide an ED at home service to keep people out of the emergency department. Makes a lot of sense. It’s a lot more cost effective, but more importantly, patients don’t have to go to an overcrowded ED, I should say, so we’re helping managing ED bed blocks as well.
So I hope that gives you some insights into what we are doing and how we’re doing it. It has to be third party accredited and it has to be safe. Only then can you provide Intensive Care at Home now.
And also have a look at our membership for families in intensive care and Intensive Care at Home 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.
We also provide NDIS nursing assessments. We employ a team of critical care nurses. We employ hundreds of years of critical care nursing experience in the community that is unmatched in 2023 in the community in Australia.
And if you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home. Click the like button, click the notification bell, share the video with your friends and families and comment below what you want to see next or what questions and insights you have.
Thank you so much for watching.
This is Patrik Hutzel from intensivecareathome.com, and I will talk to you in a few days.
Take care for now.