Wound care management: tracheostomy and gastrostomy

Abstract

Approximately 10-15% of patients requiring mechanical ventilation will ultimately undergo tracheostomy (2). In a large prospective cohort study, up to 34% of patients who required mechanical ventilation for more than 48 hours needed tracheostomy placement (3). More than half of the patients who underwent tracheostomy also required PEG placement for prolonged nutritional needs (4,5). In this article, we review appropriate post-procedural care for PDT and PEG, as well as possible complications that can develop.

Patient education on PEG tube care at home

“…Once the PEG tube is inserted, it must remain in place until the tract has matured for at least 4 weeks 4. It can take as long as 6 to 8 weeks for the tract to mature if the patient has delayed wound healing.…”

“…There may be issues with excessive granulation tissue leading to a buildup of pink or red tissue around the PEG tube insertion site resulting in discomfort. This can be treated by using silver nitrate to cauterize that area 4. The granulation tissue will turn a grayish/white color and will slough off without additional intervention.…”

“…The head of the bed should remain elevated, 30 to 45 degrees, while administering liquid through the PEG tube to prevent aspiration. 4…”

“…Once the PEG tube is inserted, it must remain in place until the tract has matured for at least 4 weeks. 4 It can take as long as 6 to 8 weeks for the tract to mature if the patient has delayed wound healing. If the PEG tube is removed prior to tract maturation, gastric contents could spill through the immature tract into the peritoneal cavity.…”

Prevention and management of minor complications in percutaneous endoscopic gastrostomy

“…A close professional relationship and good communication between the care givers (eg, nurses team, the nutrition support (nurse) specialist, wound ostomy nurse, endoscopist or radiologist) result in good periprocedural preparation and early identification and management of potential problems 19–23. Preventive actions and management options are summarised below 2–4 6 19 21 24–29…”