A Do Not Intubate (DNI) is a legal order that tells a healthcare team that a patient does not want to be intubated in the event of a life-threatening situation. A Do Not Intubate order means that chest compressions and cardiac drugs may be used during a patient’s care, but that no breathing tube will be placed within the patient. Intubation involves a doctor inserting a flexible plastic tube through the nose or mouth into the trachea (windpipe) to help with breathing. This tube is then usually connected to a ventilator machine that pushes oxygen into the lungs.
DNI & DNR Legal Orders
A DNI is not the only legal order that can be obtained, so it’s important to understand what the other options are and what they allow or do not allow. A Do Not Resuscitate (DNR) order means that no CPR will be performed, to include chest compressions, cardiac drugs, or placement of a breathing tube. The main difference between a DNI and a DNR is that a DNI allows medical professionals to perform chest compressions and provide cardiac drugs.
Choosing a Do Not Intubate Order
Opting for a DNI can be a difficult decision to make for your loved one with a life-limiting illness.. However, a DNI can be withdrawn at any time, and your hospice healthcare team can periodically verify that the patient’s wish to keep the order in place. This means that if circumstances or feelings change, the DNI can be easily removed. DNI’s only apply to situations where a patient has no pulse or is not breathing, but they do not restrict any other clinically indicated care. There does not need to be a formal advance directive or living will to have DNR and DNI orders in place. However, if there is a living will, it is important that the legal order is on record.
When Is a DNI Appropriate??
DNI’s are usually requested when a patient is near their end of life or has life limiting condition that will likely not improve.. In cases of serious medical conditions, DNI’s are usually appropriate when the focus of treatment shifts from curative to ensuring the patient’s comfort. Sometimes, the patient will make the choice to request a DNI in advance which will be recorded in their medical chart. This is most often the case with a terminal illness.
Are There Risks That Come With a DNI?
Your loved one may elect for a DNR instead of a DNI, in which case they do not wish to be resuscitated at all. They may instead, however, choose a DNI where they wish to avoid intubation. This decision is usually made by a patient who wishes to avoid relying on a ventilator and any complications that can sometimes occur with intubation. While it is very rare, intubation may cause heart attacks, lung infections, strokes, and temporary mental confusion for patients diagnosed with terminal conditions.
Patients Who Are Unable to Choose DNI
There are instances, however, when a patient would benefit from a DNI, but is unable to make the decision for themselves.. If faced with this difficult situation, you may experience some hesitancy or inhibitions towards making a decision about your loved one. It is important to consult with your hospice care team before making any decisions so you can make the most informed choice that is best for your loved one. In situations where your loved one may experience heart failure or respiratory arrest, opting for a DNI may be the most appropriate decision to prevent these conditions from occurring.
How Do I Make a Decision for a DNI?
To start the decision process, you should speak to your loved one first and listen to their opinion on whether they want intubation. Next, you should speak to your hospice medical team do gain a full understanding of the situation. Typically, a DNI is requested when the patient is in a severe enough condition where they are nearing their end-of-life. If you are making the decision for your loved one, it is important to trust that you are making the correct, most informed choice that both of you are most comfortable with.If your loved one already has established a DNI order for themselves, you will be unable to revoke their DNI order, regardless of how you may feel about their choice. Having a conversation with your loved one about their choice can help you gain more comfort and acceptance of their decision.
Contact Harbor Light Hospice
Making decisions about DNI orders can be a difficult and confusing. In addition to speaking to your loved one, it is important to discuss the process in depth with your hospice care team. They can help you better understand the details of a DNI order and the options you have before making a decision or when coping with the decision your loved one has made. Speak to a hospice care professional at Harbor Light Hospice for more information on Do Not Intubate orders and assistance with how to begin the process.
