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Over the last few decades, tracheostomy has been increasingly performed in children with various complex and chronic conditions. We have seen a dramatic change in indications for tracheostomy in pediatric patients due to better survival of premature infants and those suffering from severe congenital anomalies. There is no consensus about the timing of tracheostomy in pediatric patients. Although percutaneous tracheostomy has become the standard of care for adults, there is not sufficient evidence to start performing it routinely in pediatric patients. The indications, preoperative considerations, and different procedures for tracheostomy in children are reviewed. Surgical tracheostomy is described step by step placing an emphasis on safety measures to minimize complications. There is also a great variability in tracheostomy care protocols in the literature. Post-operative tracheostomy care is discussed for the early and late post-operative periods. There is no general consensus on decannulation protocols, but prevailing expert opinion is presented. There is growing evidence in support for an interdisciplinary approach to pediatric tracheostomized patients. The focus of this paper is the review of the literature regarding safety improvement strategies from the surgical and post-operative point of view.

INTRODUCTION Tracheostomy is defined as the surgical procedure for creating an opening at the 3rd or 4th cartilage ring in the anterior wall of the trachea to provide airway patency. It was known that tracheostomy is regarded as the oldest known life-saving method. Tracheostomy care involves a complex care process that requires knowledge and skills for elderly patients and their caregivers. This study was conducted to investigate the effect of tracheostomy training, provided to caregivers of patients with tracheostomy, on caregivers' burden and knowledge levels regarding the tracheostomy care. METHODS The study population consists of caregivers who provide home care for patients with tracheostomy who were divided into two groups as the control group (n = 30) and the experimental group (n = 30) with the separation of the patients admitted to the outpatient clinic. RESULTS In the intergroup comparison of experimental and control group post-test score averages, the difference between the Zarit Caregiver Burden Scale score averages and the mean knowledge scores was found to be statistically significant (p

There have been reports of successful quality-improvement initiatives surrounding tracheostomy care for more than a decade, but widespread adoption of best practices has not been universal. Five key drivers have been found to improve the quality of care for tracheostomy patients: multidisciplinary synchronous ward rounds, standardization of care protocols, appropriate interdisciplinary education and staff allocation, patient and family involvement, and use of data to drive improvement. The Global Tracheostomy Collaborative is a quality-improvement collaborative dedicated to improving the care of tracheostomy patients worldwide through communication, dissemination, and implementation of proven strategies based on these 5 key drivers.

A Pediatric Tracheostomy Care Index (PTCI) was developed by the authors to standardize care and drive quality improvement efforts at their institution. The PTCI comprises 9 elements deemed essential for safe care of children with a tracheostomy tube. Based on the PTCI scores, the number of missed opportunities per patient was tracked, and interventions through a "Plan-Do-Study-Act" approach were performed. The establishment of the PTCI has been successful at standardizing, quantifying, and monitoring the consistency and documentation of care provided at the authors' institution.

Background: A tracheostomy is a surgical procedure in which an opening is made into the anterior wall ofthe trachea.With an increasing demand for intensive care beds more nurses in acute and high dependencywards will be expected to care competently for patients with tracheostomy tubes.Aim: To evaluate Nurses’ knowledge and skills in performing tracheostomy care and to determine theeffectiveness of the educational training program on nurses knowledge and skills.Methods: A quasi-experimental study (one group) conducted at Sinnar Teaching Hospital (STH). A totalcoverage technique was used 45 nurses were included.measurements of the group were made both beforeand after training program.Results: The total knowledge percentage before training program ranged from (2.2%) to (46.7%), andafter training program,ranged from (57.8%) to (88.9%). 91.1% of respondents (41) they were not attendingtraining course in Tracheotomy Care before.There was statistically significant different in the mean totalknowledge score of the participants before and after the program at p value level = (0.00).Conclusion: The nurses included in the study do not have adequate knowledge and skills in the evidencebasedguidelines for tracheostomy care.There is no correlation between the qualifications or years ofexperience and knowledge of nurses regarding tracheostomy care.Continuing professional developmentprogramme ontracheostomy care should be made compulsory for all nurses.

The COVID-19 pandemic worldwide has led to the establishment of a large number of field hospitals created to facilitate emergency intensive care facilities outside the routine hospital setting notably created in the USA, India and China. The Nightingale Hospital arose within a conference centre in London with an initial capacity of 500 ventilated beds and potentially 4000 patients in total based on initial forecasts. As part of the Nightingale Hospital, we faced the challenge of overseeing potential management of ventilated tracheostomy patients within this unique field hospital setting. Given the potential morbidity associated with tracheostomy care and specific care needs, a key …

PURPOSE: Traditional critical care dogma regarding the benefits of early tracheostomy during invasive ventilation has had to be revisited due to the risk of COVID-19 to patients and healthcare staff. Standard practises that have evolved to minimise the risks associated with tracheostomy must be comprehensively reviewed in light of the numerous potential episodes for aerosol generating procedures. We meet the urgent need for safe practise standards by presenting the experience of two major London teaching hospitals, and synthesise our findings into an evidence-based guideline for multidisciplinary care of the tracheostomy patient. METHODS: This is a narrative review presenting the extensive experience of over 120 patients with tracheostomy, with a pragmatic analysis of currently available evidence for safe tracheostomy care in COVID-19 patients. RESULTS: Tracheostomy care involves many potentially aerosol generating procedures which may pose a risk of viral transmission to staff and patients. We make a series of recommendations to ameliorate this risk through infection control strategies, equipment modification, and individualised decannulation protocols. In addition, we discuss the multidisciplinary collaboration that is absolutely fundamental to safe and effective practise. CONCLUSION: COVID-19 requires a radical rethink of many tenets of tracheostomy care, and controversy continues to exist regarding the optimal techniques to minimise risk to patients and healthcare workers. Safe practise requires a coordinated multidisciplinary team approach to infection control, weaning and decannulation, with integrated processes for continuous prospective data collection and audit.

Einleitung: Die vorliegende Arbeit beschäftigt sich mit den Herausforderungen und der Edukation bezüglich Tracheostomapflege von Pflegepersonen im gehobenen Dienst, den Patient*innen selbst und deren Caregiver. Fehlendes Wissen, Unsicherheit und mangelnde Edukation des Pflegepersonals, der Patient*innen selbst und deren Caregiver führt zu Komplikationen und lebensbedrohlichen Situationen. Methodik: Die Methodik dieser Arbeit nach wissenschaftlichen Kriterien ist eine strukturierte Literaturrecherche. Es wurde mit den zentralen Begrifflichkeiten nach themenrelevanter Literatur gesucht. Die gefundene Literatur wurde mit standardisierten Bewertungsbögen analysiert. Die analysierte Literatur wurde zur Beantwortung der gesetzten Fragestellungen verwendet. Ergebnisse: Die Ergebnisse der Literaturrecherche wurden systematisch analysiert, zusammengefasst und in vier Kernkapitel Herausforderungen des Pflegepersonals, Edukation des Pflegepersonals, Herausforderungen der Betroffenen und deren Caregiver und Schulung der Betroffenen und deren Caregiver unterteilt. Schlussfolgerung: Die Zusammenfassung ergibt, dass vor allem bei Pflegepersonen auf Normalstationen ein großes Wissensdefizit und Unsicherheit bezüglich der Tracheostomaversorgung besteht und eine Edukation dieser für das Leben der Betroffenen unumgänglich ist. Zusätzlich ist sie essentiell für die Schulung und Beratung der Betroffenen und deren Caregiver, welche sich bei der Versorgung zu Hause ebenfalls großen Herausforderungen stellen müssen. Introduction: The present work deals with the challenges and the education regarding tracheostomy care of nurses, the patients themselves and their caregiver. Lack of knowledge, uncertainty and lack of education of the nursing staff, the patients and their caregiver leads to complications and life-threatening situations. Methodology: The methodology of this work according to scientific criteria is a structured literature search. The key terms were used to find relevant literature. The literature was analyzed using standardized evaluation sheets. The analyzed literature was used to answer the research questions. Results: The results of the literature search were systematically analyzed, summarized and divided into four core chapters challenges of nursing staff, education of nursing staff, challenges of sufferers and their caregiver and education of sufferers and their caregiver. Conclusio: The summary shows that there is a lack of knowledge and uncertainty regarding tracheostomy care, especially among nursing staff on normal wards and the education in this area is essential for the lives of the patients. In addition, it is essential for the training and counseling of patients and their caregiver, who also have to face challenges in the care at home.

Background The recent outbreak of SARS-CoV-2 has become pandemic since it began in late 2019. Tracheostomy is considered an aerosol-generating procedure which increases potential viral exposure to the health care staff. Main body Since many patients diagnosed with SARS-CoV-2 underwent tracheostomy, the need for a standardized practice for tracheostomy tube change and care is mandatory. Articles listed in PubMed and guidelines from the otolaryngology societies were reviewed, and the state-of-the-art practice related to the topic is highlighted. Conclusions Tracheostomy care in COVID-19 patients requires significant decision-making and preparation to carry out the task in a safe way and eliminate the risk of viral transmission.

Background & Objective: COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues. Methods: We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers. Results: Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse. Conclusion: The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers. doi: https://doi.org/10.12669/pjms.36.7.3518 How to cite this:Khan E, Lal S, Hashmi J, Thomas J, Malik MA. Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines. Pak J Med Sci. 2020;36(7):1714-1718. doi: https://doi.org/10.12669/pjms.36.7.3518 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

• COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. • The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. • We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU. • We developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers. Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse. • The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach for PCDT offers an extra level of safety to healthcare workers.

The Breatheasy© Tracheostomy Program based at the Red Cross War Memorial Children's Hospital, Cape Town, manages children mostly from poor socio-economic backgrounds. In our resource-limited setting, it is unclear how these families cope with the demands of a tracheostomised child. We aim to assess the quality of life (QOL) of tracheostomised children and their families as the first study of its kind in a low-resource setting.A descriptive, observational study was done to assess the QOL of tracheostomised children managed by the Breatheasy© Program over 10 months. Children with tracheostomies for longer than 6 months, complex syndromic children, and home ventilated children were included. The validated Paediatric Tracheotomy Health Status Instrument (PTHSI) was utilised, where a higher score implied a better outcome.A total of 68 families were recruited. In 57 (85.1%) of the carers, the highest level of education achieved was primary or high school. Twenty-seven (42%) families reported having an annual household income of less than $675 US Dollars (ZAR10,000). Sixteen (24%) resided within informal housing. The mean scores for the 4 PTHSI domains were: physical symptoms 24.8/35 (70.9%), frequency/financial impact of medical visits 14.2/15 (94.7%), QOL of child 8.8/15 (58.7%), QOL of carer 62.3/85 (73.3%); the overall score was 110.2/150 (73.5%). There was no significant correlation between total PTHSI and annual household income, carer's educational status or type of housing. Children with a concomitant major medical condition had a significantly poorer total PTHSI scores (p-value 0.024).Tracheostomy care compounds challenging socio-economic circumstances. In our experience, with adequate training, home-care nursing is not necessary. Despite difficult living conditions, the Breatheasy© Program empowers children and their families to live independently of the hospital system and appear to be thriving. The decision to perform a paediatric tracheostomy should not be influenced by the carer's education level, socio-economic status, or on the basis of formal or informal housing. Children with major medical comorbidities represent a group that requires more support.

Highlights • Aerosol Generating Procedures(AGP) and interventions are challenging during COVID -19. • During Emergencies AGP poses a major threat to health care workers and other patients. • Minimisation of aerosolisation is best achieved by techniques such as closed suctioning and enhanced use of HME.

The objective of this study was to examine the characteristic, content, and role of Paediatric Intensive Care Units (PICUs) in the provision of follow-up for children and their families' post-intensive care discharge in the United Kingdom (UK) and Republic of Ireland (RoI). The study followed a descriptive self-reported, web-based survey design. "In-hospital PICU follow-up" was defined as follow-up delivered by the PICU team following PICU discharge but before hospital discharge and "post-discharge PICU follow-up" was defined as follow-up delivered by the PICU team following hospital discharge. The survey was administered to all 28 PICUs in the UK and RoI. Paediatric intensive care medical directors or delegated individuals participated. Data were collected between September 2017 and January 2018 with a response rate of 79% (n = 22/28). Twelve units provided either in-hospital and/or post-discharge PICU follow-up. Ten (45%) PICUs reported providing in-hospital follow-up, with half (n = 5) using an eligibility criteria for in-hospital follow-up, which related to disease groups. The most frequently reported form of in-hospital PICU follow-up consisted of face-to-face patient consultation (n = 8) by a PICU doctor (n = 5) and/or nurse (n = 4). The time at which initial contact was made was usually not predetermined (n = 4) and the assessment of care needs included are tracheostomy care (n = 4), respiratory care (n = 4), and sedative medication weaning plan (n = 5). Four PICUs reported to provide post-discharge follow-up. This involved telephone (n = 2), follow-up clinic consultations (n = 1) or home visits (n = 1), provided predominantly by PICU doctors (n = 2), with their activity directed by patient needs (n = 3). Despite increasing evidence to suggest PICU survivors and their families experience negative sequalae post-PICU discharge, less than half of PICUs surveyed provide in-hospital follow-up and only a minority provide post-discharge follow-up. There is variation in the delivery, content, and format of in-hospital and post-discharge PICU follow-up in the UK and RoI.

Tracheotomy in the pediatric population creates unique challenges for parents. Parents often feel underprepared to provide adequate tracheostomy care. Social media is used as a resource for many medical conditions. We looked at Facebook use among parents of children with a tracheostomy to determine how this resource is used as support and to assess common concerns that require improved education prior to discharge. We joined 8 Facebook groups focused on children with a tracheostomy, analyzed the posts for how the groups were used, and identified recurring content. The primary focus of the groups was parental support and general information about tracheostomy care. A common theme identified was patients not receiving medical supplies on time, and groups provided a forum to obtain supplies. Groups also provided general advice about how to travel with a tracheostomy and medical advice, such as when to worry about blood in the tracheostomy tube.

Hintergrund: Krebserkrankungen im Hals-Nasen-Ohren Bereich zählen zu den seltenen Krebserkrankungen in Österreich. Eine Bösartige Entstehung von Tumoren des Larynx bedarf jedoch häufig eine Laryngektomie und somit ein Anlegen von einem Tracheostoma. Im postoperativen Bereich bedeutet dies besondere Vorsicht für Pflegepersonen. Eine konsequente und standardisierte Pflege der Betroffenen kann die Entstehung von möglichen Komplikationen reduzieren und im besten Fall verhindern. Gesundheits- und Krankenpflegepersonen sollten daher über ein gewisses Fachwissen bezüglich der Kanülenpflege verfügen. Ziel: Ziel dieser Arbeit ist es, herauszufinden, welche Risikofaktoren und Komplikationen sich nach einer Laryngektomie für Patient*innen sowie für das Pflegepersonal ergeben. Weiteres wird in der Arbeit die Pflege von Patient*innen mit einem Tracheostoma analysiert. Methode: Für diese Arbeit wurde eine systematische Literaturrecherche in wissenschaftlichen Datenbanken durchgeführt. Es wurde in CINAHL und Pubmed recherchiert, um relevante Studien für die Arbeit zu erhalten. Mit festgelegten Ein- und Ausschlusskriterien konnten somit zwölf Studien zur Beantwortung der Forschungsfrage herangezogen werden. Ergebnisse: Pahryngokutane Fisteln, Wundheilungsstörungen sowie Blutungen zählen zu den häufigsten Komplikationen bei frisch laryngektomierten Patient*innen. Die Pflegemaßnahmen sowie die Verwendung von Hilfsmitteln spielen in der postoperativen Phase eine wichtige Rolle. Weiteres sollten regelmäßige Schulungen und Weiterbildungen von Gesundheits- und Krankenpflegepersonen eingeführt werden. Diskussion: Über eine optimale Pflege von frisch laryngektomierten Patient*innen bestehen nur geringe hochwertige Studien. Die Entstehung von Komplikationen im akuten Setting sind keine seltenen Vorfälle und benötigen daher mehr Aufmerksamkeit. Background: Cancer in the ear, nose and throat area is one of the rare cancers in Austria. However, malignant tumors of the larynx often require a laryngectomy and thus a tracheostomy. In the postoperative area, this means special care for caregivers. Consistent and standardized care of those affected can reduce the occurrence of possible complications and at best prevent them. Healthcare professionals should therefore have some expertise in cannula care. Objective: The aim of this work is to find out which risk factors and complications arise after a laryngectomy for caregivers and patients. In addition, the care of patients with a tracheostoma is analyzed in the work. Methode: For this work a systematic in scientific databases was carried out. It was researched in CINAHL and Pubmed to obtain relevant studies for the work. With defined inclusion and exclusion criteria, twelve studies could therefore be used to answer the research question. Results: Pahryngocutaneous fistulas, wound healing disorders and bleeding are among the most common complications in freshly laryngectomized patients. The care measures and the use of aids play an important role in the postoperative phase. In addition, regular training and further education for health and nursing staff should be introduced. Discussion: There are only small, high-quality studies on the optimal care of freshly laryngectomized patients. Complications in the acute setting are not uncommon and therefore require more attention.

A 50 year male with motor neurone disease who has a cuffed tracheostomy for 2 months and is on home ventilation was admitted with respiratory distress. On admission he has laboured breathing, low oxygen saturation and had diminished air entry in right lung. It was difficult to negotiate suction catheter. An emergent change of tracheostomy tube was done with relief of dyspnea.

Purpose The purpose of this quality improvement project was to create a Tracheostomy Subject Matter Expert (Trach SME) Committee to standardize tracheostomy care, education, and the discharge process across Boston Children's Hospital. Design and Methods Boston Children's Hospital (BCH) is a free-standing urban tertiary pediatric hospital with 15 inpatient units. The newly formed Trach SME Committee evaluated the discharge process across the enterprise including hospital satellites and intra-hospital practice. Education materials were centralized, and policies were reviewed, revised and standardized to reflect current best practice. The Trach SME provided education to Trach Champions from each area that became resources for their respective units. The Trach SME also developed measurement outcomes to assess the effectiveness of the education process. Results In the implementation year of 2104, our 7-day unplanned readmission rate for tracheostomy patients was 18.18%. This rate decreased to 6.67% in 2015 and to 0% in 2016. In 2015, we began to monitor 30-day unplanned readmissions and the rate was 6.67% in 2015 and decreased to 0% in 2016. Conclusions and Practice Implications Standardization of policies, procedures and caregiver educational materials for the management of patients with a tracheostomy tube improved tracheostomy care across the enterprise and reduced tracheostomy readmission rates.

Background The aim of this study was to investigate the effects of using a systematic approach to tracheostomy care by a clinical nurse specialist and surgical intensivists for patients with a tracheostomy who were transferred from the surgical intensive care unit (SICU) to the general ward. Methods In this retrospective study, subjects were limited to SICU patients with a tracheostomy who were transferred to the general ward. The study period was divided into a preintervention period (January 1, 2007 to December 31, 2010) and a postintervention period (January 1, 2011 to December 31, 2014), and electronic medical records were used to analyze and compare patient characteristics, clinical outcomes, and readmission to the SICU. Results The analysis included 44 patients in the preintervention group and 96 patients in the postintervention group. Decannulation time (26.7±25.1 vs. 12.1±16.0 days, P=0.003),length of stay in the general ward (70.6±89.1 vs. 40.5±42.2 days, P=0.008), length of total hospital stay (107.5±95.6 vs. 74.7±51.2 days, P=0.009), and readmission rate of SICU decreased due to T-cannula occlusion (58.8% vs. 5.9%, P=0.010). Conclusions Using a systematic approach to tracheostomy care in the general ward led to reduction in decannulation time through professional management, which resulted in a shorter hospital stay. It also lowered SICU readmission by solving problems related to direct T-cannula.

Purpose/aims Many critically ill patients undergo a tracheostomy. Tracheostomy care is performed to maintain the airway and promote stoma skin integrity. Variation in practices may affect outcomes. The study purpose was to describe tracheostomy care practices of caregivers who perform tracheostomy care in critical care settings and compare practices with published recommendations. Design This is a descriptive, exploratory study of tracheostomy care practices of nurses and respiratory therapists using a simulated setting. Methods Staff working in critical care and step-down units were approached to participate in the study. Equipment used for tracheostomy care and the steps performed were observed and video recorded. Observations were compared with recommended practices. Data were analyzed with descriptive statistics. Results Fifteen registered nurses (75%) and 5 respiratory therapists (25%) participated. Most participants (80%) were female and held a baccalaureate degree; median experience was 5 years. Equipment used and order of steps varied widely. Only 1 individual performed in the order recommended in a commonly used procedure manual. The most common sequence performed was hand hygiene, clean flange, clean stoma, change inner cannula, change ties, and apply dressing. Conclusion Wide variability in equipment and practices emphasizes the need for establishing an evidence-based approach for performing tracheostomy care to prevent complications.

CERVOXY CLIN; International audience; We present the cases of two laryngectomised patients who were treated for granulomas of the tracheostomy orifice with a silver nitrate pencil. During tracheostomy care, the tip broke off, was aspirated and fell into the bronchial tree. Necrotising ulcerative injuries of the right bronchial tree with clear delineation were found without lesions in the subsegmental division. To prevent the risk of secondary stenosis of the small airways induced by the spread of silver nitrate, we did not irrigate with saline solution as previously reported. Antibiotherapy and endoscopic monitoring were performed. Complete healing in 4–6 weeks was found without stenosis of the bronchial tree or bleeding.

Objective To determine if standardization of perioperative tracheostomy care procedures decreased the incidence of hospital-acquired tracheostomy-related pressure ulcers. Methods All patients at least 18 years old who underwent placement of a tracheostomy tube in the operating room from July 1, 2014, through June 30, 2015, were cared for postoperatively through an institutionally adopted quality improvement protocol. This included 4 elements: (1) placement of a hydrocolloid dressing underneath the tracheostomy flange in the postoperative period, (2) removal of plate sutures within 7 days of the tracheostomy procedure, (3) placement of a polyurethane foam dressing after suture removal, and (4) neutral positioning of the head. One year after the bundle was initiated, a retrospective analysis was performed to compare the percentage of tracheostomy patients who developed pressure ulcers versus the preintervention period. Results The incidence of tracheostomy-related pressure ulcers decreased from 20 of 183 tracheostomies (10.93%) prior to use of the standardized protocol to 2 of 155 tracheostomies (1.29%). Chi-square analysis showed a significant difference between the groups, with a P value of .0003. Discussion Adoption of this care bundle at our institution resulted in a significant reduction in the incidence of hospital-acquired tracheostomy-related pressure ulcers. The impact of any single intervention within our protocol was not assessed and could be an area of further investigation. Implications for Practice Adoption of a standardized posttracheostomy care bundle at the institution level may result in the improved care of patients with tracheostomies and specifically may reduce the incidence of pressure ulcers.

Siekiant sumažinti skyriuose slaugomiems pacientams, kuriems išvesta tracheostoma, priežiūros sukeltų komplikacijų skaičių, labai svarbu, kad slaugytojai sekreto išsiurbimo iš tracheostomos vamzdelio procedūrą atliktų saugiai ir veiktų vadovaudamiesi moksliniais tyrimais pagrįstomis rekomendacijomis. Šio tyrimo tikslas buvo išanalizuoti slaugytojų žinias ir įgūdžius atliekant sekreto išsiurbimą iš tracheostomos vamzdelio. Tyrimas vyko Kauno miesto ligoninių skyriuose, į kuriuos tracheostomuoti pacientai dažniausiai patenka iš Intensyviosios terapijos skyrių. Pirmojo tyrimo etapo metu buvo vykdoma slaugytojų anketinė apklausa, antrojo - slaugytojų praktikinių veiksmų, atliekant sekreto išsiurbimą iš tracheostomos vamzdelio, stebėjimas. Anketinėje apklausoje dalyvavo 93 slaugytojai, buvo stebėtos 99 sekreto išsiurbimo iš tracheostomos vamzdelio procedūros. Tyrimo duomenims rinkti buvo naudojama autorių sukurta Slaugytojų žinių nustatymo anketa ir Slaugytojų praktikinių veiksmų stebėjimo protokolas. Rezultatai. Registruojant požymius, rodančius sekreto išsiurbimo iš tracheostomos vamzdelio poreikį, dažniausiai buvo stebimas paciento kosulys (77,8 proc.), apie pusės stebėtų atvejų metu melsvėjo paciento veidas ir lūpos (42,4 proc.). Apklausos metu 81,0 proc. slaugytojų nurodė, kad sekretą siurbia, kai pacientas kosėja ir 52,4 proc. – kai pacientas pats paprašo (lyginant su stebėj. χ²=64,681;lls=1;p

Tracheostomy can be associated with numerous complications. Here, we present a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue causing malpositioning of tracheostomy tube and airway obstruction, secondary to prolong placement of a cuff tracheostomy tube due to improper tracheostomy care. This case illustrates that awareness and knowledge of proper tracheostomy tube care among medical personnel are very important to avoid any mismanagement that can cause life-threatening complications.

Objectives To perform a needs-based assessment for tracheostomy care education for nonsurgical first responders in the hospital setting and to implement and assess the efficacy of a targeted tracheostomy educational program. Methods A prospective observational study conducted between October 2017 and May 2018 including emergency medicine (EM) residents, internal medicine (IM) residents, and intensive care unit (ICU) advanced practice providers at 2 tertiary hospitals. Needs-based assessments were conducted, leading to specialty specific curricula. One-hour educational sessions included didactics and case-based simulation. A pre- and posttest objective knowledge quiz and self-assessment were administered, and a posttest was repeated at 6 months. Results There were 85 participants (13 ICU, 40 EM, 32 IM). Significant improvement ( P < .05) in mean objective knowledge score was seen across all groups between pre- and postintervention assessments with relative but not significant improvement at 6 months. There were significant increases in comfort level from pre- to postintervention. At 6-month follow-up, comfort level remained significantly increased for the majority of questions for the EM group and for select questions for IM and ICU advanced practice provider groups. Discussion Nonsurgeons are often first responders to critical airway situations yet receive limited formal education regarding tracheostomy. We demonstrated improvement in knowledge and comfort after a targeted educational module for tracheostomy care and management. Implications for Practice Although tracheostomy care is multidisciplinary, specialty-specific education may provide a more relevant foundation on which to build skills. Prompt and effective management of tracheostomy emergencies by first responders may improve patient safety and reduce mortality.

The feasibility and safety of pediatric tracheostomy care at home by parents is challenging. Many physicians are not confident of sending tracheostomized children home. We describe our experience with 12 children who underwent tracheostomy and were sent home. Nine children were successfully decannulated. With proper training of parents, the outcome of home tracheostomy seems good.

Advances in technology have led to novel teaching methods enabling students to learn in a reality-like environment with all their senses. The new generation of students who have individualistic learning styles one different from the other and tend to use technology with ease has made it necessary to use diverse teaching methods in this respect. Virtual reality activities based on gaming, a new method in psychomotor skills acquisition, is a simulation technique where a computerized skill with an integrated game enables one to experience being in a real-life environment sending signals to one’s sensory organs. The subject about the care given through tracheostomy, which is given within the course of the Fundamentals of Nursing that includes basic skills, is an application with strict requirements in terms of aseptic conditions, and for which students hardly find a possibility to practice. For this reason, software was developed for the application of a virtual reality game in accordance with the procedural steps of tracheostomy care and installed in students’ mobile phones. With this article we aim to share the experience we gained in the preparation process of the game-based virtual reality application and its contribution to the teaching of psychomotor skills. Extended English summary is in the end of Full Text PDF (TURKISH) file . Ozet Teknolojideki ilerlemeler ogrencilere gercek ortamdaymis hissi veren ve tum duyularina hitap eden yeni ogretim yontemlerinin ortaya cikmasini saglamistir. Ozellikle yeni kusak ogrencilerin teknolojiyi kullanmaya yatkinligi ve her bireyin birbirinden farkli ogrenme stillerine sahip olmasi, bu konuda cesitli ogretim metotlarinin kullanilmasi gerekliligini aciga cikarmistir. Psikomotor beceri ogretiminde yeni bir ogretim teknigi olan oyun tabanli sanal gerceklik uygulamasi, herhangi bir yerde olmayi hissettiren ve bunun icin duyu organlarimiza cesitli bilgiler saglayan gercek ortamlara benzer bir becerinin bilgisayara aktarilip oyunlastirildigi bir simulasyon yontemidir. Temel beceri uygulamalarinin verildigi Hemsirelik Esaslari dersi iceriginde yer alan trakeostomi bakimi konusu ogrencilerin uygulama imkani bulmakta zorlandiklari, asepsi kosullara uygunlugunun onemli oldugu bir uygulamadir. Bu nedenle trakeostomi bakimi islem basamaklarina uygun olarak oyun tabanli sanal gerceklik uygulamasinin yazilimi yapilmis ve ogrencilerin cep telefonlarina yuklenmistir. Bu makalenin amaci oyun tabanli sanal gerceklik uygulamasinin hazirlanma surecindeki deneyimlerimizi ve psikomotor beceri ogretimine katkisini paylasmaktir.

Introduction Airway Obstruction is a medical emergency that provides an artificial airway support such as the use of endotracheal tubes or creating tracheostomy. To sustain the patency of the airway, a competent nurse is required to deliver care for such kind of patients. Aim The aim of the study was to assess nurses’ knowledge and practices regarding tracheostomy care among patients with tracheostomy tube. Methodology A quantitative approach, using a cross sectional descriptive study design was used. A convenient sample of 80 nurses working in internal medicine, surgical ward and intensive care units at (RMH) was selected. An adapted structured questionnaire was used to collect data. Descriptive and Inferential statistics were used to analyzed the data. Results The majority of nurses (71%) had moderate knowledge, 26.5% lower knowledge and Only 2(2,5%) of nurses had high knowledge on tracheostomy definition, types and care. Regarding practice of nurses, a greater number [78(97.5%)] exhibited low levels and only 2(2.5%) with high level of practice regarding the tracheostomy care. There were no significant demographic factors associated with knowledge and practice of nurses. Conclusion The level of knowledge and practice was limited. Therefore, in-service continuous professional development for registered nurses working in the internal medicine, surgical ward and ICU is highly recommended for further research to elicit the major contributory factors that led to inadequate knowledge and practice.

BACKGROUND: Multidisciplinary tracheostomy teams have been successful in improving operative outcomes; however, limited data exist on their effect on postoperative care. We aimed to determine the effectiveness of a multidisciplinary tracheostomy service alone and following implementation of a post-tracheostomy care bundle on rates of decannulation and tolerance of oral diet before discharge. METHODS: Prospective data on all subjects requiring tracheostomy by any trauma/critical care surgeon were collected from January 2011 to December 2013 following development of a tracheostomy service and continued following implementation of the post-tracheostomy care bundle. Rates of decannulation and tolerance of oral diet were compared between all groups: pre-tracheostomy service (baseline, historical control), tracheostomy service alone, and tracheostomy service with post-tracheostomy care bundle. RESULTS: Three hundred ninety-three subjects met the criteria for analysis with 61 in the baseline group, 124 following initiation of a tracheostomy service, and 208 after the addition of the post-tracheostomy care bundle. There were significant overall differences between all groups in the proportion of subjects decannulated, proportion of subjects tolerating oral diet, and number of subjects receiving speech evaluations. Pairwise comparisons showed no differences in decannulation or tolerance of oral diet following implementation of the tracheostomy service alone but significant improvement with the addition of the post-tracheostomy care bundle compared with baseline. (P = .002 and P = .005, respectively). Likewise, the number of speech language pathologist consults significantly increased compared with baseline only after the post-tracheostomy care bundle (P = .004). Time to speech evaluation significantly decreased with the post-tracheostomy care bundle compared with baseline and tracheostomy service (P CONCLUSIONS: The addition of a post-tracheostomy care bundle to a multidisciplinary tracheostomy service significantly improved rates of decannulation and tolerance of oral diet.

Objectives: In standard medical school and residency curricula, there is little formal training in the acute or chronic management of tracheostomies, yet consistent and correct care is critical to prevent and treat complications. The objective of this study was to assess the knowledge and comfort level of non-otolaryngology healthcare providers in the care of adult patients with a tracheostomy. Further, this study evaluated the effectiveness of an easily reproducible 1-hour workshop, employing both didactics and simulation, to enhance comfort and knowledge surrounding care of patients with tracheostomies. Methods: Eighty-five participants across different medical specialties, levels of training, and care roles were included in this cohort study. The simulation included three 10-minute stations: 1) understanding the component parts of standard adult tracheostomy tubes, 2) management of a dislodged tracheostomy tube, and 3) management of a patient with a tracheostomy who cannot be ventilated. Participants completed a pre- and post-intervention self-assessment and multiple-choice questionnaire assessing comfort and knowledge. Results: The 1-hour workshop increased participants’ comfort and knowledge. For the seven comfort-based questions, the average comfort level increased from 2.24 pre-intervention to 4.09 on a Likert scale (p < 0.001). For the eight knowledge-based questions, the average correct response rate increased from 36% to 69% (p < 0.001). Conclusions: In this study, we demonstrated that there are significant knowledge and comfort deficits among non-otolaryngology healthcare professionals caring for patients with tracheostomies. The easily reproducible 1-hour workshop employed may be an effective starting point for improving knowledge of and comfort with adult tracheostomy care.

Objectives Tracheostomy-related pressure injuries (TRPI) have been demonstrated to occur in approximately 10% of tracheostomy patients. In this study, we present TRPI outcomes after implementation of a standardized tracheostomy care protocol. Methods A tracheostomy care protocol was developed by an interdisciplinary quality improvement program and implemented on July 1, 2016. The protocol was designed to minimize factors that contribute to the development of TRPI. Rates of TRPI over the subsequent 20 months were compared to the year before implementation. Results 9 out of 85 patients (10.6%) developed TRPI in the pre-protocol cohort compared to 0 of 137 (0%) in the post-protocol cohort, which was a statistically significant decrease by Fisher's exact test with a p-value of 0.0001. Pearson's correlation coefficient demonstrated a negative correlation between age and post-operative day of diagnosis (r = −0.641, p = 0.063), indicating that older patients develop TRPI more quickly. Conclusions Interdisciplinary peri-operative tracheostomy care protocols can be effective in decreasing rates of TRPI.

Tracheostomy is a common life-saving surgical procedure, which has its own short- and long-term surgical complications. Occasionally, after being in place for several years, the tube may fracture, causing a foreign body reaction in the bronchus followed by life-threatening pneumonia. We report a rare case of a 29-year-old man with a known leukodystrophy disorder whose tracheostomy tube was never changed in 14 years. He presented with signs of sepsis and respiratory distress. The management and intraoperative findings, including recommendations for tracheostomy care, were described.