Preventing Complications of Pediatric Tracheostomy Through Standardized Wound Care and Parent Education

Gaudreau, Philip; Greenlick, Hannah; Dong, Tiffany; Levy, Michelle; Hackett, Alyssa M.; Preciado, Diego; Zalzal, George H.; Reilly, Brian K.

doi:10.1001/jamaoto.2016.1803

Cited by 50 publications

(38 citation statements)

References 22 publications

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“…While patients are increasingly complex and require the input of multidisciplinary teams and healthcare professionals, we hope that the publication of these guidelines will support standardised training for multidisciplinary staff . Standardised, structured educational programmes are also of benefit to parents and carers and may have a positive impact on carer confidence and patient safety in the community . The NTSP has developed e‐learning, resources and courses to support these guidelines (http://www.tracheostomy.org.uk).…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

et al. 2018

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Summary Temporary and permanent tracheostomies are required in children to manage actual or anticipated long‐term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

et al. 2018

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“…It is not surprising that over 95% of tracheostomy manipulations are by nurses and respiratory therapists as they provide the majority of patient care. Our hospital has as specialized nursing protocol which has reduced the frequency of tracheostomy wound complications . This protocol encourages frequent wound check which contribute to the high nursing numbers.…”

Section: Discussionmentioning

confidence: 99%

“…11 Changes in care with system wide practices, specialized nursing, and education protocols have decreased complications of tracheostomy wounds. [11][12][13] However, this diligence for wound surveillance has created a culture of frequent tracheostomy manipulations which can increase…”

Section: Discussionmentioning

confidence: 99%

“…Our hospital has as specialized nursing protocol which has reduced the frequency of tracheostomy wound complications. 13 This protocol encourages frequent wound check which contribute to the high nursing numbers. Specific tracheostomy related training focusing on how to safely manipulate the tracheostomy may help prevent complications with manipulations.…”

Section: Complicationsmentioning

confidence: 99%

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Tracheostomy manipulations: Impact on tracheostomy safety

Espinel

Scriven

Shah

2019

Pediatric Investigation

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Importance Tracheotomy is one of the riskiest procedures for composite morbidity within pediatric otolaryngology. During the postoperative period, each time the tracheostomy tube is manipulated, there is opportunity for morbidity (e.g. a patient is vulnerable to accidental decannulation and airway loss). Objective To identify areas of improvement in caring for “fresh tracheostomy” patients by determining the number of times a tracheostomy tube is manipulated from placement until discharge. The hypothesis is that the more a tracheostomy is manipulated, the higher probability of morbidity. Methods A quality improvement initiative was conducted to map the care of patients who underwent tracheostomy placement over 12 months. Tracheostomy care and manipulation by all providers were reviewed. Complications, wound care, and respiratory treatments were also evaluated. Results Patients were hospitalized for an average of 39 days (7–140) following tracheostomy. The first tracheostomy tube change occurred on average 6 days (5–10) following placement. Tracheostomy tubes were manipulated an average of 6 (2.5–11.9) times a day to amount to 216 (51–1091) times between placement and discharge. Bedside nurses and respiratory therapists were responsible for 95% of these actions; physicians accounted for 4%. There were 6 tracheostomy related complications. Three were accidental decannulations resulting in cardiopulmonary arrest. One of these caused long term patient morbidity. Patients with more than 4 manipulations per day during the 2 weeks following tracheostomy tube placement, were more likely to have a tracheostomy related complication than those with less than 4 (OR: 12.5; 95% CI: 1.2–130.6; P = 0.0349). Interpretation While uncommon, complications related to tracheostomy can have serious long term effects and at best prolongs length of stay for patients. Reducing the number of tracheostomy manipulations may provide safer postoperative care ultimately reducing morbidity and potentially mortality; children on average have 6 tracheotomy manipulations/day with only 2% being by the physician.

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“…Así como las indicaciones de traqueostomía y el perfil epidemiológico de los pacientes pediátricos que requieren este procedimiento han experimentado cambios importantes en las últimas décadas, la morbimortalidad y sus complicaciones relacionadas también se han modificado notablemente 3 . Adicionalmente, numerosos autores han destacado que las complicaciones son más frecuentes en niños que en adultos [3][4][5] , ya que a menudo cuentan con múltiples factores predisponentes y comorbilidades médicas, sumado a la vulnerabilidad asociada a las características anatómicas y fisiológicas propias del niño 6 .…”

Section: Introductionunclassified

Complicaciones de traqueostomía en pacientes pediátricos. Revisión de la literatura

Villamor

2018

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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Las indicaciones de traqueostomía en niños han cambiado considerablemente en los últimos años, así como el perfil epidemiológico de los pacientes y la morbimortalidad de este procedimiento. Las complicaciones de este procedimiento pueden ser clasificadas en intraoperatorias, inmediatas y tardías. La mortalidad global en pacientes pediátricos llevados a traqueostomía oscila entre el 13% y 19%. Sin embargo, menos del 5% es directamente atribuible a la cirugía. La presente revisión abarcará las complicaciones más frecuentes asociadas a traqueostomía pediátrica con recomendaciones en su prevención y manejo.

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Preventing Complications of Pediatric Tracheostomy Through Standardized Wound Care and Parent Education

Cited by 50 publications

References 22 publications

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

Tracheostomy manipulations: Impact on tracheostomy safety

Complicaciones de traqueostomía en pacientes pediátricos. Revisión de la literatura

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