Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision
making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was
My Dad In ICU Has Pressure Sores. Is It A Sign Of Bad Nursing Care?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“ I want to answer the succeeding questions from one of my clientsPeter as part of my 1:1
consulting and advocacy service! asking why his dad acquired multiple infections and pressure sores. Does having such poor technique in the rehab facility contributed mainly to these?
My Dad Got Multiple Infections and Pressure Ulcers in the Rehab Facility. Was there medical negligence on the part of the ICU team?
“You can also check out previous 1:1 consulting and advocacy session with me and Peter here.”
PART 1
PART 2
PART 3
PART 4
PART 5
PART 6
Peter: Yes, He was.
Patrik: So that’s okay.
Peter: I’m glad we don’t have bad things to talk about right now.
Patrik: Sorry.
Peter: I said I’m glad we don’t have bad things to talk about.
Patrik: That’s right. I mean it’s still like your dad is in hospital but at least he’s moving forward.
Peter: Yeah. And that bothers me now, you know?
Patrik: Of course. I mean, yes he’s moving forward. We don’t have bad things to talk about for now, but at the end of the day he will need care and support.
Peter: Probably, a lot. Yes.
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Patrik: How are you?
Peter: Chap, I’m very sorry to bother you, I hope it’s not too early over there.
Patrik: Can I, is it okay if I called you back in about an hour?
Peter: About oh …
Patrik: Is it urgent?
Peter: Yeah, well it’s pressing, put it that way?
Patrik: Sorry?
Peter: It’s kind of pressing.
Patrik: Right, okay, yeah, yeah, go on. Go on.
Peter: I’m very sorry to bother you at this time. I-
Patrik: No, no.
Peter: It’s just that I’m on the way up to see my father. He’s had multiple infections over the last, since the last time I talked with you. He’s been in and out of this rehab, and this last infection he had three bacteria that got into his blood.
Now, I don’t know, I think what’s happened … He’s feeling good now, he’s looking good, and he’s on antibiotics, IV. But this rehab, I think they get very callous. They have very poor technique, the nurses aides in there, and he’s got an ulcer on his bottom, a couple ulcers that they promoted, let’s put it that way.
Now he’s feeling good and he’s got the tracheostomy and they want to see him back there now. Meanwhile, his urine’s thick with that, I’m sure you’ve seen when that yeast gets clogged in the urine? You know, the yeast grows and makes the urine all mucky?
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Peter: Yep.
Peter: It makes the urine real thick?
Patrik: Yep.
Peter: They call it sediment but it’s really like mostly like growing out of yeast.
But anyway, what’s happening with that, that stuff actually clogs up his catheter and blocks from going sometimes, and but what I’m getting at is I asked for them to see my father, to see a urologist, and they wouldn’t until I filed a protest with Medicare, and they actually agreed with me. They usually don’t, they think the
doctor’s right.
So they’re letting me keep him here, and the thing is that they want me to push him … from your experience, I know you’re not a doctor and all that, but he’s a patient with this filthy muck in the urine. They’re mostly growing candida. Do they treat that generally down the way?
Patrik: You know, most of the time, when this happens the way you described this, it sounds to me like your dad is dehydrated.
Peter: Well, they watch his electrolytes every day and they say his lytes are okay, creatinine‘s good, potassium.
It appears that they’re giving him plenty of water, so, I mean, I think … and the urine doesn’t look dark. It’s just thick, yellow, whitish, muck. It’s almost like if you took sand and you poured it in there and it’s just, it’s actually almost like a thick, I’m trying to get the idea. Like a tooth-
Peter: Hello?
Patrik: Hi Peter, sorry, you dropped out. Okay, can I just ask, since we last spoke is your dad still in the same facility?
Peter: Hello?
Patrik: Hi Jim, it’s Patrick again, sorry.
Peter: I got three bars on my side so I don’t know how you’re doing on your side.
Patrik: No, I have four bars actually, that’s okay. When we last spoke, your dad is still in the same facility?
Peter: Yeah and they want to transfer him right now. They want to-
Patrik: Why?
Peter: Did you say why?
Patrik: Yeah.
Peter: Because he’s on antibiotics and they have to administer IV antibiotics, but there’s a company that comes to the house and does that and I’ve actually been trained to do it with the nurse and the aide has done it and for some reason they don’t want to send him home with me. Plus the fact he’s off of the vent, and this rehab slash nursing home, I guess they want him back, but every time we go back they’re supposed to prep him for going
home. They’re supposed to get me supplies, suction supplies and they don’t do anything. It’s like pulling teeth trying to get them to help him and they don’t like the help there. They’re not being careful, apparently, and he gets this big infection from the E. coli. That usually tells you what, right?
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Patrik: Absolutely.
Peter: They’re not careful. He had E. coli in his blood.
Patrik: That’s terrible.
Peter: So I don’t know how the hell they manage that.
Patrik: I can tell you probably how that might have happened. So you’re talking about he’s got the infection, you said he’s got a pressure sore on his back, doesn’t he, on his sacrum?
Peter: Yes, he’s got one on his bottom, but see I don’t think they change their gloves when he goes to the toilet and they clean him. I think they keep the same gloves on and then they start doing that.
Patrik: Right, but you see, you can count two and two together there, Peter. So, for example, if he has this pressure sore and he’s opening his bowel, there’s a very good chance that’s how the E.Coli goes in his bloodstream. It goes through the wound. Does that make sense?
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Peter: Well, yeah, that’s what I thought and they said, well, not necessarily. It could have gone through the feeding tube. It could’ve gone through the, what do you call, through the, what’s the other one?, the suprapubic catheter. It could’ve gone down at a trache opening. Yeah, but
how does it get into the bloodstream? How does it cross over the barrier?
Patrik: Yeah, yeah.
Peter: It was probably through the wall. Most likely it went right into the open sore, right?
Patrik: Yeah, absolutely, but most likely it happened either through the pressure sore or through the suprapubic catheter, either or.
Peter: But I’m saying they probably weren’t being careful with him.
Patrik: Oh, very much so, very much so. Are they working with registered nurses or are they working with nursing aides? Do you know?
Peter: It seems that they work with the RNs and the RNs do not, from what I’ve seen, they let them do what they will have to do and they do not correct them.
They don’t stand there with them while they’re washing my father. They let them have, and I’ve seen them where they don’t put him on his side properly even after the ulcer and they get mad at me for saying it. Well, the reason too, it’s sad, I thought with them trying to push me back to that rehab. They’ve already shown me how to suction the trache and all I need is just the supplies. All I need is humidified, I have oxygen. All I need is a humidifier, the tubing,
the little trache mat, and then I’m set. And the IV, there’s a group that comes to the house and can give him the IV antibiotics. Did you ever see those little globes that they put the medicine into like a little globe? It’s under pressure and they hook it up to you and then you get your IV that way?
Patrik: Oh yeah, yeah.
Peter: Yeah, that’s what they do and they do it at home.
Patrik: Of course.
Peter: I don’t know why they keep having him going back there. It’s almost like they don’t wanna let him go home. And when they had him they gave him three infections.
Patrik: I’m not surprised, yeah. Can I just ask, Jim, so you’re talking about, he’s got sediments in his urine and it looks very cloudy, right?
Peter: Well, it looks thick like, you know? As if you were looking at, you know, like you had water and then sand at the bottom, like sand actually filling the loop, you know?
Patrik: Yeah.
Peter: And the stuff, it separates from the urine. The urine actually is clear itself but it’s just that this stuff that sits and floats and they’re not treating it. Do you guys typically treat fungus or yeast in the urine?
Patrik: Oh, absolutely, absolutely.
Peter: They say people with catheters, it’s chronic and that it will only come back and the people that have a suprapubic catheter that it’s only going to get yeast again, but this stuff here, it just plagues him. These things are dry. You give him one dose of yeast maybe, It grows so big.
Patrik: Can I just ask, with the suprapubic catheter, how often do they change the suprapubic catheter? Do you know?
Peter: It’s like every six weeks.
Patrik: Okay, do you know when it has last been changed?
Peter: Maybe four weeks ago.
Patrik: Okay.
Peter: Maybe three.
Patrik: Right.
Peter: We should probably do it more often, not less.
Patrik: Yeah. So, what I can see here, Peter, is number one, they might have to change the suprapubic catheter more often, especially if it’s yeast in there.
Number two, what’s really important, I understand the urine is looking pretty cloudy, is that the way you would describe it? Cloudy? There’s sediments in there, is that how you would describe it?
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Peter: Yeah. They separate out, so it looks a lot clearer when this stuff settles down, the yeast, it settles to the bottom.
Patrik: Yeah. The next thing that really is, if urine output, put below, and again I’m referring to they might have to give him more water.
Peter: I asked them yesterday and they said he’s fine.
Patrik: Right. I question that. I question that. Do you know how much fluid he’s getting in 24 hours?
Peter: He’s getting 20 CCs an hour of the saline solution. Do you guys, over heard net pro.
Patrik: Net pro? Okay, yep. How much an hour?
Peter: 20 a time.
Patrik: Okay. Is he getting-
Peter: 24.
Patrik: Right.
Peter: Giving him 200 of water every six hours.
Patrik: Okay. So, it’s not, what’s your dad’s weight, roughly?
Peter: Oh, I don’t know, less than 200.
Patrik: Okay. So, okay that sounds about accurate. 200 every six hours, that’s 1200 in 24 hours, plus 40 every hour, so that’s about 40 times 800, it’s about 2 litres a day. I tell you, it’s not enough. It’s not enough. Not enough. And what are your dad’s, it’s not enough fluids. Not enough fluids to keep the catheter flushed through. What’s your dad’s, what are your dad’s kidneys doing?
Peter: They say they’re okay. I haven’t gone up today. I’m on my way up right now. I’m gonna try to push, they want to move to go back to rehab, but right now he’s in the neuro intensive, neuro unit. He had a couple of little jitters in his right arm and little twitches, so they put him on a night dose of Keppra.
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Patrik: Okay.
Peter: And some other medicine. Enough to take away the shake, a little bit of shaky, it seems like it’s helping him be a little bit more awake too. Anyway, I just want to know, I’m just concerned about going back to that-
Patrik: Oh, absolutely.
Peter: They did have pretty good doctors at the rehab place and they did help him with a few issues he’s had with high sodium, high potassium, high sodium and some other issues with, what do you call it, what’s the word? The instructions, I mean, they have different approach. I also got him weaned off of the ventilator. They’re good with ventilators, keeping him off, and I’ve got to give them some credit. It just worries me that now he doesn’t, I’m no doctor, but he doesn’t need to get weaned off of the Ventilator/ breathing machine and he doesn’t need, they’re telling me all his blood’s stable, so. Here’s what’s happening, they want to watch him, this nursing group, what do you call this, this rehab place. They’re actually got to sit on him for two to three weeks until he gets another infection. I could have him at home.
Patrik: Absolutely.
Peter: My father gets an infection about once every four to six weeks. That’s just the way it is-
Patrik: And that’s the urinary, is that infection-
Peter: Yeah, the urinary or he gets the congestion stuff and he has to go on IV antibiotics and that type of stuff. What I’m saying is they want to keep him in there. Between these trips, they want him to stay there and then they want to just drag this out forever. I mean, I think they keep him as a patient, it’s a long term acute care facility. I think they want to keep him there. They don’t like us to keep coming back and forth. They
don’t like us coming in once a month. Why can’t he stay home three weeks? And then it’d be better care, too. If they keep him they won’t even put him, and see what gets me, they won’t even put him, I have a four inch ROHO cushion, they got a one inch and they won’t let me use mine.
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Patrik: So, he’s not getting out of bed?
Peter: No. They’re leaving him in bed.
Patrik: That’s terrible.
Peter: It has to heal, I said, but I got a four inch ROHO.
Patrik: Yeah.
Peter: And theirs was a one inch. It’s like a rock. It’s a joke. But that’s all we have and that’s what you have to use. That’s what I don’t like about this place. They’re very strict in there and they won’t let me use the four inch ROHO underneath him.
Patrik: That’s terrible. Here is another thing, Peter, you mentioned high potassium and high sodium, right?
Peter: Yeah, he goes up sometimes.
Patrik: Again, that’s a sign that they’re not giving him enough water. It’s a sign.
Peter: That’s one we know that his kidneys is not the best. Every time he gets sick they said every time he gets an infection his kidney function gets screwy. So they said we’ve, got to bring him in.. Anytime he gets these problems with potassium and sodium, 99% it’s apparently becoming clear now that he’s developed an infection. And we have to bring him in.
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
Patrik
