Implementation of an interdisciplinary tracheostomy care protocol to decrease rates of tracheostomy-related pressure ulcers and injuries

Carroll, Daniel J.; Leto, Christopher J.; Yang, Zao; Fritz, Mark; Ho, Brian; Byrd, J. Kenneth; Groves, Michael W.; Dellsperger, Kevin C.; Kountakis, Stilianos E.; Postma, Gregory N.

doi:10.1016/j.amjoto.2020.102480

Cited by 11 publications

(20 citation statements)

References 10 publications

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“…The need for tracheostomy dressing should be assessed carefully, with dressing changes performed only when soiled to decrease tracheostomy tube manipulation. Sites should be reevaluated daily 90 . Xeroform dressings, custom tracheostomy tubes with stoma seals, and Silflex silicone pads can improve the seal around the tracheostomy and decrease aerosolized viral particles.…”

Section: Discussionmentioning

confidence: 99%

“…Sites should be reevaluated daily. 90 Xeroform dressings, custom tracheostomy tubes with stoma seals, and Silflex silicone pads can improve the seal around the tracheostomy and decrease aerosolized viral particles. Disposable inner cannulas are preferred to avoid risks from cleaning and handling reusable inner cannulas.…”

Section: Complications Of Prolonged Intubation And/or Tracheostomymentioning

confidence: 99%

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Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

Meister

Pandian

Hillel

et al. 2020

Otolaryngol.--head neck surg.

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Objective In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. Data Sources PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. Review Methods Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. Conclusions Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. Implications for Practice Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.

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Section: Discussionmentioning

confidence: 99%

Section: Complications Of Prolonged Intubation And/or Tracheostomymentioning

confidence: 99%

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

Meister

Pandian

Hillel

et al. 2020

Otolaryngol.--head neck surg.

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“…Careful assessment of the stoma site using an interdisciplinary care protocol, therefore, is imperative. 59 Patency of tracheostomy tubes is confirmed by passing inline suction through a closed circuit, ensuring that the suction catheter passes freely beyond the distal tip of the tracheostomy tube without sticking or blockage.…”

Section: Tracheostomy Tube Carementioning

confidence: 99%

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

Pandian

Morris

Brodsky

et al. 2020

American Journal of Critical Care

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Purpose Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. Methods Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations. Results Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident. Conclusion Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.

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“…Although pressure injuries are defined by the CMS as "never events," previous literature has suggested that approximately 11% to 13% of patients requiring a tracheostomy develop TRPIs. 2,3 With the arrival of newer tracheostomy tube designs, it is possible that the incidence of some adverse events may decrease. For example, the Shiley flexible tracheostomy tube has a clear, soft flange, which was designed to reduce contact with the stoma site and increase air flow.…”

mentioning

confidence: 99%

“…Adverse events and outcomes for tracheostomy patients are relatively understudied, particularly for conditions such as skin infections and TRPI. Although pressure injuries are defined by the CMS as “never events,” previous literature has suggested that approximately 11% to 13% of patients requiring a tracheostomy develop TRPIs 2,3 . With the arrival of newer tracheostomy tube designs, it is possible that the incidence of some adverse events may decrease.…”

mentioning

confidence: 99%

Response to “An Interprofessional Approach to Preventing Tracheostomy-Related Pressure Injuries”

Borg

D’Angelo

Liu

2022

Adv Skin Wound Care

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We read with great interest the recent quality improvement initiative by Urquhart et al, 1 focused on preventing tracheotomy-related pressure injuries (TRPIs). The authors addressed an important gap in tracheostomy research, and we are encouraged to see that with the TRPI-prevention bundle, the daily rate of TRPIs decreased by 50%. Although this is a strong improvement in patient care, this effort also indicates that a TRPI-prevention bundle alone may not be enough to prevent TRPIs in patients with tracheostomies.What the initiative did not include was the type of tracheostomy tube used and whether enhanced tracheostomy tube design can impact the incidence of TRPI. Adverse events and outcomes for tracheostomy patients are relatively understudied, particularly for conditions such as skin infections and TRPI. Although pressure injuries are defined by the CMS as "never events," previous literature has suggested that approximately 11% to 13% of patients requiring a tracheostomy develop TRPIs. 2,3 With the arrival of newer tracheostomy tube designs, it is possible that the incidence of some adverse events may decrease. For example, the Shiley flexible tracheostomy tube has a clear, soft flange, which was designed to reduce contact with the stoma site and increase air flow. This enhanced feature may help clinicians detect skin breakdown through visualization of the underlying skin, which could enable clinicians to intervene earlier to prevent TRPI. Other tracheostomy tube manufacturers have developed similar design features and warrant evaluation in a clinical setting.We hope additional clinical research will build off of the work of Urquhart et al and examine adverse events such as TRPIs while incorporating how modern tracheostomy tube designs may impact patient outcomes. •

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Implementation of an interdisciplinary tracheostomy care protocol to decrease rates of tracheostomy-related pressure ulcers and injuries

Cited by 11 publications

References 10 publications

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

Response to “An Interprofessional Approach to Preventing Tracheostomy-Related Pressure Injuries”

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