Evidence-Based Care of Children With Tracheostomies: Hospitalization to Home Care

Abstract

Routine tracheostomy care in children maintains airway patency, minimizes infection, and ensures skin integrity around the tracheostomy stoma to prevent complications. Using evidence-based recommendations for care of the mature tracheostomy limits variation in practice and leads to better patient outcomes in all care settings. Incorporating evidence-based care into practice is especially important because children with tracheostomies are at high risk for morbidity and mortality. The purpose of this review is to summarize the most current, evidence-based literature for pediatric tracheostomy care, including stoma care and tracheostomy suctioning. Rehabilitation nurses can then include these best practices when caring for children with tracheostomies and when educating caregivers who provide tracheostomy care to children at home.

Effects of the Discharge Education Program on Family Caregivers Caring for Patients on Mechanical Home Ventilation in Korea: A Pilot Test

“…This is similar to the literature that shows better performance after education interventions. [25][26][27][28][29] However, the experimental group only showed a significant difference in the disinfecting timing and infection symptoms 1 week after discharge. Maintaining airway clearance and managing complications for infection prevention is crucial for tracheostomy management.…”

“…Maintaining airway clearance and managing complications for infection prevention is crucial for tracheostomy management. 26,30 Therefore, it is necessary to add content that can arouse higher recognition of the importance of caregiving through tracheostomy management, including infections and complication cases.…”

Moisture-Associated Skin Damage

“…Securement of tracheostomy ties or tube sufficiently tight to avoid life-threatening removal of the tube, along with prevention of medical device–related pressure injury when the ties are excessively tight, was described. Best practice standards also recommend selection of an absorbent prepackaged tracheostomy dressing rather than cotton gauze in order to avoid inadvertent introduction of cotton fibers into the respiratory system 34…”

“…Available guidelines for nursing care tend to focus on suctioning and securement methods for tracheostomy tubes. [34][35][36] Generalized recommendations for peristomal skin care include cleansing with saline and avoidance of hydrogen peroxide. Securement of tracheostomy ties or tube sufficiently tight to avoid life-threatening removal of the tube, along with prevention of medical device-related pressure injury when the ties are excessively tight, was described.…”

“…Best practice standards also recommend selection of an absorbent prepackaged tracheostomy dressing rather than cotton gauze in order to avoid inadvertent introduction of cotton fibers into the respiratory system. 34 Limited evidence provides a basis for additional interventions for prevention and management specifically designed at reducing exposure of the peristomal skin to respiratory secretions. Considered collectively, available evidence suggests that a solid skin barrier is more effective than an absorbent dressing or gauze placed over the peristomal skin of a tracheostomy.…”