Patient safety and the prevention of skin and mucosal lesions associated with airway invasive devices

Abstract

Objective:To analyze the care implemented by the nursing team to promote the safety of adult patients and prevention of skin and mucosal lesions associated with the presence of lower airways invasive devices. Method: Study with qualitative and quantitative approach, descriptive and exploratory type, whose investigative scenarios were adult inpatient units of a hospital in the West Frontier of Rio Grande do Sul. The study subjects consisted of nurses, nursing technicians and nursing assistants. Results: A total of 118 professionals were interviewed. We highlight the observed specific care with endotracheal tube and tracheostomy, management and assessment of the cuff and the criteria used to secretion aspiration. Conclusion: There is a superficial nursing work in the patient direct care and a differentiation in relation to the perception of nurse technicians, especially those working in the intensive care unit, who presented major property and view of the patient's clinical status. DESCRIPTORS Patient safety and the prevention of skin and mucosal lesions associated with airway invasive devicesSegurança do paciente e a prevenção de lesões cutâneo-mucosas associadas aos dispositivos invasivos nas vias aéreas La seguridad del paciente y la prevención de lesiones cutáneo-mucosas asociadas con los dispositivos invasivos en las vías aéreas INTRODUCTIONHospitalized patients in clinical units or intensive care units at some point may require the use of an airway device to replace or assist in maintaining ventilation. The use of an endotracheal tube (ET) and/or tracheostomy tube are the main instruments that composes this maintenance, allowing oxygen installation, removal of secretions and mechanical ventilation.Facing the use of these invasive devices, patients can be subjected to cutaneous and mucosal lesions in upper and lower airways. Thus, we highlight aspects related to patient safety and the onset of these adverse events that may result from the length of use, above all, the list of complex care required to maintain these devices, in which minimum failures can be translated in irreparable damage to the patient.Patient safety is aimed at reducing unnecessary harm, involving the practical actions that minimize the complications to the context and devices from which care is provided (1) . Still, patient safety is related to the actions to ensure the integrity of people, preventing adverse events and the prevention of errors, thus promoting a safer patient care (2) . Thus, care processes that permeate the care of patients who use these devices, especially those airways invasive, should focus on reducing the risk of skin and mucosal, oropharyngeal, laryngopharyngeal, laryngeal and tracheal lesions. These measures ensure the airway maintenance, important for therapy, avoiding possible temporary or permanent damage, longer hospitalizations and, consequently, the patient's suffering.Considering the security for the prevention of skin and mucosal lesions in patients undergoing lower airways invasive devices, there...

Boas práticas de enfermagem a pacientes em ventilação mecânica invasiva na emergência hospitalara

“…25 A study on nursing care implemented for the prevention of cutaneous-mucosal lesions associated with invasive devices in the lower airways drew attention to the distancing of nurses from direct care through clinical evaluation and interventions aimed at this public. 26 Regarding care directed to the mechanical ventilator and circuit, routine circuit replacement is not recommended, only when dirty Chart 1. Nursing care by category and level of studies' evidence, SC, Brazil, 2017.…”

Lesão de mucosa laringotraqueal e fatores associados após extubação endotraqueal: estudo piloto

“…(7) Studies about patient safety involving laryngotracheal injury are still incipient. (22) To minimize the occurrence of such lesions generated by the intubation process, healthcare teams must adopt preventive measures, such as rigorous and constant monitoring of intracuff pressure, adequate patient position and immobilization, adequate tube size, and carrying out tracheal aspiration.…”

Cuidados para a prevenção de complicações em pacientes traqueostomizados

“…The tracheostomy should be aspirated carefully and this was one of the care that emphasized the importance of the procedure to be performed only in cases of high secretion and with caution in the introduction of the probe so as not to injure the mucosa during the procedure. 9 is corroborated, suctioning of the tracheostomy, which should not be a routine procedure and should be adapted individually for each patient, being indicated in cases in which the patient is unable to expectorate alone the secretions. It was also commented by the authors on the need for correct use of aspiration pressure, which can not be above 120 mmHg, as it causes lesions on the mucosa and also can not be very low (below 100 mmHg), because it does not remove secretions.…”

“…23 It was verified that the Nursing team's care for the promotion and prevention of cutaneous and mucosal lesions associated with the presence of invasive devices in the lower airways were: the dressing with physiological saline and aqueous chlorhexidine, in addition to the exchange of the lace once per shift and whenever necessary, in addition to the use of neck protectors such as gauzes around the tracheostomy and oil for protection of the skin. 9 It is recommended that the tracheostomy be cleaned at least once a day with 0.9% SF and the replacement of the lace should also be done daily to ensure the integrity of the peristomal skin. 10,13,18,22 Reminds it is important that the lace is always clean and dry 21 and the cleaning frequency of the stoma site will depend on the individual and the amount of secretions.…”