An Evidence Based Evaluation of Tracheostomy Care Practices
An Evidence Based EvaluationAn Evidence Based Evaluation
of Tracheostomy Care Practicesof Tracheostomy Care Practices
Melissa D. Dennis-RouseMelissa D. Dennis-Rouse RN BSN CENRN BSN CEN
Judy E. DavidsonJudy E. Davidson RN MS CCRN FCCMRN MS CCRN FCCM
• Discuss the reasons behind doing thisDiscuss the reasons behind doing this
evidence based projectevidence based project
• Review the methods usedReview the methods used
• Discuss the results of the projectDiscuss the results of the project
• Adverse outcomes related to trachealAdverse outcomes related to tracheal
occlusion and peri-tracheal skinocclusion and peri-tracheal skin
breakdown stimulated this reviewbreakdown stimulated this review
• An evidence based approach was takenAn evidence based approach was taken
• Organizational tracheostomy careOrganizational tracheostomy care
policies were reviewedpolicies were reviewed
• Literature review was doneLiterature review was done
• National experts were surveyedNational experts were surveyed
• A geographical survey was doneA geographical survey was done
• Vendors of tracheostomy supplies wereVendors of tracheostomy supplies were
Level of evidenceLevel of evidence
(each green triangle represents 1 source)(each green triangle represents 1 source)
Methods (continued)Methods (continued)
• Subcategories related to tracheostomySubcategories related to tracheostomy
care were queried:care were queried:
• Securing devicesSecuring devices
• Sutures and their removalSutures and their removal
• Type and choice of dressingsType and choice of dressings
• Prevention of skin breakdownPrevention of skin breakdown
• Frequency of care and role delineation andFrequency of care and role delineation and
• The stocked dressing was tooThe stocked dressing was too
large to fit under sutureslarge to fit under sutures
• Conflicting policies regardingConflicting policies regarding
tracheostomy care were foundtracheostomy care were found
• None identified responsibility for performing careNone identified responsibility for performing care
• Respiratory vs Nursing or time standards for careRespiratory vs Nursing or time standards for care
• Skin maceration on the neck was foundSkin maceration on the neck was found
on multiple auditson multiple audits
• The type of tie was a problemThe type of tie was a problem
• Nurses and Respiratory TherapistsNurses and Respiratory Therapists
were having difficulty providingwere having difficulty providing
tracheostomy care due to suturingtracheostomy care due to suturing
technique and method of securingtechnique and method of securing
Hunt for new more absorbentHunt for new more absorbent
• COPA fenestrated foam dressings wereCOPA fenestrated foam dressings were
• RTs and RNs were educated about use andRTs and RNs were educated about use and
benefits if pt has excessive secretions.benefits if pt has excessive secretions.
• Recommend use of 3M skin barrierRecommend use of 3M skin barrier
with foam to protect skin.with foam to protect skin.
Dressing cost comparisonDressing cost comparison
• Item – Cost - QuantityItem – Cost - Quantity
• Gauze sponge 4x4-Gauze sponge 4x4- $38.48 Case of 3000$38.48 Case of 3000
• Gauze Drain sponge fenestrated (forGauze Drain sponge fenestrated (for
trach) 2x2trach) 2x2 -$75.78 Case of 1400-$75.78 Case of 1400
• Foam Sponges fenestrated (for trach)Foam Sponges fenestrated (for trach)
3.5 x 33.5 x 3 $36.18 Case of 50$36.18 Case of 50
• A list of practice changes were agreedA list of practice changes were agreed
upon by respiratory, nursing andupon by respiratory, nursing and
medical staffmedical staff
• New supplies were trialedNew supplies were trialed
• Primary responsibility for tracheostomyPrimary responsibility for tracheostomy
care was shifted to the registered nursecare was shifted to the registered nurse
• Policies and procedures were revisedPolicies and procedures were revised
• Education was provided to staffEducation was provided to staff
ReferencesReferences• Cofone, E. (n.d.).Cofone, E. (n.d.). Why use a foam dressing?Why use a foam dressing? [Pamphlet]. Warwick: Tyco Healthcare Group.[Pamphlet]. Warwick: Tyco Healthcare Group.
• Dixon, L. and Wasson, D. (1998). Comparing use and cost effectiveness of tracheostomyDixon, L. and Wasson, D. (1998). Comparing use and cost effectiveness of tracheostomy
• tube securing devices.tube securing devices. MedSurg Nursing, 7MedSurg Nursing, 7(5), 270-275.(5), 270-275.
• Docherty,B. (2002, October). Tracheostomy management for patients in general wardDocherty,B. (2002, October). Tracheostomy management for patients in general ward
• settings. Retrieved March 22, 2007, fromsettings. Retrieved March 22, 2007, from
• Lynn-McHale Wiegand, D.J. & Carlson, K.K. (Eds). (2005).Lynn-McHale Wiegand, D.J. & Carlson, K.K. (Eds). (2005). AACN Procedure Manual forAACN Procedure Manual for
• Critical CareCritical Care (5th ed.). Philadelphia: Elsevier.(5th ed.). Philadelphia: Elsevier.
• Lutz, J.B. (2002).Lutz, J.B. (2002). Performance assessment of film forming barriers (skin sealants)Performance assessment of film forming barriers (skin sealants) [Pamphlet].[Pamphlet].
• St. Paul: 3M Health Care.St. Paul: 3M Health Care.
• Melnyk, B.M. & Fineout-Overholt, E. (2005).Melnyk, B.M. & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare.Evidence-based practice in nursing & healthcare.
• Philadelphia: Lippincott Williams & Wilkins.Philadelphia: Lippincott Williams & Wilkins.
• Phipps, W.J., Monahan, F.D., Sands, J.K., Marek, J.F. & Neighbors, M. (2003).Phipps, W.J., Monahan, F.D., Sands, J.K., Marek, J.F. & Neighbors, M. (2003). Medical-Medical-
• surgical nursing health and illness perspectivessurgical nursing health and illness perspectives (7th ed.). St. Louis: Mosby.(7th ed.). St. Louis: Mosby.
• Serra, A. (2000). Tracheostomy care.Serra, A. (2000). Tracheostomy care. Nursing standard,Nursing standard, 14, 45-55.14, 45-55.
• St. John, R.E. & Malen Feldman, J. Contemporary issues in adult tracheostomySt. John, R.E. & Malen Feldman, J. Contemporary issues in adult tracheostomy
• managementmanagement.. (2004).(2004). Critical Care Nursing Clinics of North America.Critical Care Nursing Clinics of North America. 16, 413-430.16, 413-430.
• Taber's Cyclopedic Medical DictionaryTaber's Cyclopedic Medical Dictionary (17th ed.) (1989). Philadelphia, PA: F.A. Davis(17th ed.) (1989). Philadelphia, PA: F.A. Davis
• Woodrow, P. (2002). Managing patients with a tracheostomy in acute care.Woodrow, P. (2002). Managing patients with a tracheostomy in acute care. NursingNursing
• Standard, 16, 39-48.Standard, 16, 39-48.