Otolaryngologists Reach Consensus on Standardized Care for Tracheostomy Patients

Overall, the panel achieved consensus on 77 items that they believe influence tracheostomy care and are essential to improving care among patients with a tracheostomy tube. Areas covered include tracheostomy tube selection, care and maintenance; tracheostomy tube cuffs; complications; patient/caregiver education; pediatric tracheostomy care; and adult tracheostomy care. Although the statement does address issues specific to pediatric and adult tracheostomy care, as indicated by the last two areas, the conscensus statement overall provided guidance on tracheostomy care that pertains to both adult and pediatric patients.

Among the 77 items, the panel identified 13 key statements:

1. The purpose of the consensus statement is to improve care among pediatric and adult patients with a tracheostomy.
2. Patient and caregiver education should be provided prior to performing an elective tracheostomy.
3. A communication assessment should begin prior to the procedure when nonemergent tracheostomy is planned.
4. All supplies to replace a tracheostomy tube should be at bedside or within reach.
5. An initial tracheostomy tube change should normally be performed by an experienced physician, with the assistance of nursing staff, a respiratory therapist, medical assistant or assistance of another physician.
6. In the absence of aspiration, tracheostomy tube cuffs should be deflated when a patient no longer requires mechanical ventilation.
7. In children, prior to decannulation, a discussion with family regarding care needs and preparation for decannulation should take place.
8. Utilization of a defined tracheostomy care protocol for patient and caregiver education prior to discharge will improve patient outcomes and decrease complications related to their tracheostomy tube.
9. Patients and their caregivers should receive a checklist of emergency supplies prior to discharge that should remain with the patient at all times.
10. All patients and their caregivers should be evaluated prior to discharge to assess competancy of tracheostomy care procedures.
11. Patients and their caregivers should be informed of what to do in an emergency situation prior to discharge.
12. In an emergency, a dislodged, mature tracheostomy should be replaced with the same size or a size smaller tube or an endotracheal tube through the tracheostomy wound.
13. In an emergency, patients with a dislodged tracheostomy that cannot be reinserted should be intubated (when able to intubate orally) if the patient is failing to oxygenate, ventilate or there is fear the airway will be lost without intubation.

Dr. Mitchell emphasized that one key message of the consensus statement is the importance of educating the patient and family about tracheostomy care to reduce the complication rate. For example, he said that the consensus statement emphasizes involving a communication assessment before the tracheostomy is put in and making sure that patients and caregivers know how to change the tracheostomy upon discharge from the hospital. Further emphasis is placed on familiarizing caregivers and patients with emergency procedures and safety.