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Tracheostomy manipulations: Impact on tracheostomy safety
Alexandra G Espinel1, Kelly Scriven1, Rahul K Shah1
1Division of Otolaryngology Children's National Medical Center Washington DC USA.
Pediatric Investigation
|August 28, 2020
Summary
Reducing tracheostomy tube manipulations in pediatric patients may decrease serious complications and shorten hospital stays. Frequent manipulation increases the risk of adverse events like accidental decannulation and airway loss.
Area of Science:
- Pediatric Otolaryngology
- Quality Improvement Initiatives
- Patient Safety
Background:
- Tracheotomy is a high-risk procedure in pediatric otolaryngology.
- Tracheostomy tube manipulation poses a risk for patient morbidity, including accidental decannulation and airway loss.
Purpose of the Study:
- To determine the frequency of tracheostomy tube manipulations in pediatric patients from placement to discharge.
- To identify if increased manipulation correlates with higher morbidity rates.
Main Methods:
- A 12-month quality improvement initiative mapped tracheostomy care.
- Reviewed tracheostomy care, manipulation by providers, complications, wound care, and respiratory treatments.
Main Results:
- Patients averaged 39 days hospitalization; first tube change at 6 days.
- Tracheostomy tubes were manipulated an average of 6 times/day (216 total).
- Increased manipulation (>4/day) correlated with higher complication risk (OR: 12.5, P=0.0349).
Conclusions:
- Reducing tracheostomy manipulations can enhance postoperative care safety.
- Fewer manipulations may decrease morbidity and mortality, and shorten hospital length of stay.
- Physicians performed only 2% of the average 6 daily manipulations.
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