Introduction and objectives Tracheostomy tubes are used outside intensive care unit in a variety of settings. Tracheostomy tube change is a potentially high risk procedure with life threatening complications attached to it. The Respiratory Sleep and Support Centre (RSSC) at Papworth Hospital specialises in weaning patients from prolonged invasive ventilation and providing domiciliary invasive and non-invasive ventilatory support. Tracheostomy tube change is regularly undertaken for both patient groups. Review of our current clinical practice and complications related to this procedure was needed due to the risks involved.
Methods We conducted a prospective observational study of tracheostomy tube changes for patients admitted from home and those weaning from invasive ventilation in our unit. Data were collected from February to May 2014.
Results Eighteen patients receiving domiciliary tracheostomy ventilation attended during the study period. Eight patients had silver tubes, 7 had plastic cuffed tubes with inner cannulae and 1 had a plastic uncuffed tube with inner cannula. Two weaning patients were included and underwent five tracheostomy changes between them.
Data were obtained for 34 tube changes during the study period. Thirty were routine tube changes and 4 were expedited for reasons including stomal leak and partial dislodgement. Plastic tubes with inner cannulae were changed in accordance with the European Economic Community directive (1), with a mean of 28 days between tube changes. Sixteen (47%) were undertaken by consultant and 18 (53%) by trainee physician.
There were no complications in 31 (91%) tube changes. Three had minor complications such as minor bleeding and one patient who receives 24 hr home tracheostomy ventilation needed bagging and suction to clear secretions. Bronchoscopy was performed in 30 (88%) following tube change to clear respiratory secretions, check tube position and sometimes in response to a difficult tube insertion.
Conclusion No major complications occurred during the study period. This is probably because the procedure is undertaken by experienced personnel in a controlled environment. The threshold for post procedure bronchoscopy appears to be low and we are currently reviewing this aspect of our practice.
Intensive care society. Standards for the care of adult patients with temporary tracheostomy. 2008
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