The use of mobile head computed tomography (CT) equipment in intensive care is of benefit to unstable patients with brain injury. However, ionising radiation in a ward environment presents difficulties due to the necessity to restrict the exposure to staff and members of the public according to regulation 8(1-2) of the Ionising Radiation Regulations 1999. The methodology for enabling the use of a mobile head CT unit in an open ward area is discussed and a practical solution given. This required the reduction in scatter doses through the installation of extra internal and external shielding, and a further reduction in annual scatter dose by restricting the use of the equipment based on a simulation of the annual ward workload.

Introduction and ObjectivesLittle data exists regarding use of tracheostomy ventilation (TV) in patients with motor neurone disease (PwMND). NICE 2016 does not provide guidance for use of TV. Some centres offer TV as a treatment option. Data suggest TV in PwMND can prolong life and is more readily accepted by young males. It is hypothesised that starting TV in PwMND is intrusive to quality of life and leads to unacceptably, long hospital stays.Methods4 HMV centres obtained data by retrospective case-note review of patients set-up on TV as a consequence of MND between January 1998 and December 2016.Results38 patients (26 male) were included. Average age at tracheostomy was 59.3 (range 26–78). 79% (n=30) of patients had emergency tracheostomy v 21% elective. 76% (n=23) of emergencies were related to acute illness requiring intubation. 75% (n=6) of those who elected for TV wanted to live as long as possible or were struggling with continuous use of non-invasive interfaces, all of these lived with a partner or parent. 41% were managed on respiratory wards for the majority of the inpatient stay. After commencing TV, mean length of stay was 7 weeks for those admitted electively v 18 weeks as an emergency. 2 patients died in hospital. 71% were discharged to their own home. Majority of home care was undertaken by skilled carers (22 hrs/day) rather than Registered Professional (1.8 hrs/day). 3 patients were weaned, 1 successfully. Mean length of life post TV was 3.7 years (range 0–15 years), with longer life expectancy in the elective group (5.1 years). A total of 52% patients died during the timeframe. 45% of deaths were unexpected the rest expected or planned withdrawal.ConclusionTV in PwMND could be associated with increased length of life. In keeping with published data there appears to be a high incidence of unexpected death. PwMND and TV tend to be discharged to their own home with skilled carers. Length of hospital stay for planned admission is not long as is anecdotally suggested. Further work, including detailed nationwide audit, national ventilation registry and national guidance may be helpful.

IntroductionTracheostomy ventilation (T-HMV) is indicated in a small group of patients with chronic ventilatory failure. These patients often reside outside of formal health-care environments. Tracheostomy tubes generally need to be changed monthly. Our unit undertakes the majority of tube changes in the patient’s home. There are little data evaluating the safety of this procedure outside of the hospital.MethodWe conducted a retrospective review of domiciliary tracheostomy tube changes on ventilator dependent patients. Concurrently all HMV-UK network centres were sent a basic electronic survey. Data collection took place during December 2014.ResultsE-Surveys were sent to 37 centres. Responses were received from 12 (32%). 75% (n = 9) of those responding undertake the majority of tracheostomy changes in the community, 1 centre brings patients into hospital. 2 others do not routinely manage T-HMV patients. Tube changes undertaken at home, are frequently but not exclusively completed by trained professionals including care support workers. 5 areas reported that family members undertake some domiciliary tube changes.The notes of 11 ventilator dependent T-HMV patients were reviewed. Each patient had a mean 9.2 domiciliary tube changes undertaken by the respiratory outreach team. 72% (n = 66) of changes took place without complication or incident. Of the 26 changes which had documented complications, 69% related to minor bleeding only, 3 described moderate bleeding. 5 changes were associated with incidents. 3 of these related to difficulty inserting a new tube with 1 patient requiring a smaller diameter replacement tube. 1 patient, erroneously, had a wrong diameter tube inserted, this was not replaced as the patient found it more comfortable and continued to ventilate effectively. 1 change was associated with loss of speech for 24-hours post procedure. Nobody was admitted or harmed as a direct result of a tube changed at home.The notes of a further patient were reviewed. Approximately 50 domiciliary tube changes were undertaken by her brother without supervision or involvement of health care workers. There were no documented complications or admissions as a result of these changes.ConclusionDomiciliary tracheostomy tube change by trained personnel on ventilator dependent patients is safe and effective.Abstract P193 Figure 1Chart detailing the outcome of 92 domiciliary tracheostomy changes on ventilator dependent patients