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Abstract
Introduction Tracheostomy ventilation (T-HMV) is indicated in a small group of patients with chronic ventilatory failure. These patients often reside outside of formal health-care environments. Tracheostomy tubes generally need to be changed monthly. Our unit undertakes the majority of tube changes in the patient’s home. There are little data evaluating the safety of this procedure outside of the hospital.
Method We conducted a retrospective review of domiciliary tracheostomy tube changes on ventilator dependent patients. Concurrently all HMV-UK network centres were sent a basic electronic survey. Data collection took place during December 2014.
Results E-Surveys were sent to 37 centres. Responses were received from 12 (32%). 75% (n = 9) of those responding undertake the majority of tracheostomy changes in the community, 1 centre brings patients into hospital. 2 others do not routinely manage T-HMV patients. Tube changes undertaken at home, are frequently but not exclusively completed by trained professionals including care support workers. 5 areas reported that family members undertake some domiciliary tube changes.
The notes of 11 ventilator dependent T-HMV patients were reviewed. Each patient had a mean 9.2 domiciliary tube changes undertaken by the respiratory outreach team. 72% (n = 66) of changes took place without complication or incident. Of the 26 changes which had documented complications, 69% related to minor bleeding only, 3 described moderate bleeding. 5 changes were associated with incidents. 3 of these related to difficulty inserting a new tube with 1 patient requiring a smaller diameter replacement tube. 1 patient, erroneously, had a wrong diameter tube inserted, this was not replaced as the patient found it more comfortable and continued to ventilate effectively. 1 change was associated with loss of speech for 24-hours post procedure. Nobody was admitted or harmed as a direct result of a tube changed at home.
The notes of a further patient were reviewed. Approximately 50 domiciliary tube changes were undertaken by her brother without supervision or involvement of health care workers. There were no documented complications or admissions as a result of these changes.
Conclusion Domiciliary tracheostomy tube change by trained personnel on ventilator dependent patients is safe and effective.
Chart detailing the outcome of 92 domiciliary tracheostomy changes on ventilator dependent patients