The safety of home tracheostomy care for children

doi:10.1016/0022-3468(95)90034-9

Journal of Pediatric Surgery

Volume 30, Issue 8, August 1995, Pages 1246-1248

https://doi.org/10.1016/0022-3468(95)90034-9 Get rights and content

Abstract

Home tracheostomy care avoids prolonged hospitalization for tracheostomized children who must remain cannulated for a long time; however the safety aspects of this form of management are still under discussion. Since 1987 the authors have tutored parents in tracheostomy care. Once parental training was complete and the necessary equipment (aspirator, humidifier, etc) provided, children in stable condition were discharged and had period follow-up as outpatients. Thirty-four children had a total of 710 months in home care; 11 of them had decannulation. The only reported complications were two partial obstructions of the cannula and two accidental decannulations. The low number of documented accidents and the parents' profound appreciation in having their children at home indicate that patients with a tracheostomy in need of long-term care can be safely managed at home.

References (12)

JS Schlessel et al.
Tracheostomy: Acute and long-term mortality and morbidity in very low birth weight premature infants
J Pediatr Surg
(1993)
M Williams
Tracheotomy tube failure
Int J Ped Otorhinolaryngol
(1987)
WD Duncan et al.
Tracheostomy in children with emphasis on home care
J Pediatr Surg
(1992)
WC Tom et al.
Endoscopic assessment in children with tracheotomies
Arch Otolaryngol Head Neck Surg
(1993)
JB Campbell et al.
Experience with the home-care of tracheotomised paediatric patients
Arch Otorhinolaryngol
(1989)
JD Bosch et al.
Home care of the pediatric tracheostomy: Our experience
J Otolaryngol
(1987)

There are more references available in the full text version of this article.

Cited by (21)

Evaluating YouTube as a source of patient information for pediatric tracheostomy care
2023, International Journal of Pediatric Otorhinolaryngology
To evaluate YouTube's usefulness as a source of information concerning pediatric tracheostomy care.
On August 10, 2022, the top 50 YouTube search results for "pediatric tracheostomy care" were displayed. Each video was evaluated by a jury of three otolaryngologists with at least 2 years of professional experience in pediatric otolaryngology using DISCERN, scoring system of Journal of the American Medical Association (JAMA), and the Global Quality Score (GQS).
After exclusion criteria 24 videos were evaluated. Fifteen of the evaluated videos were produced by health professionals, and the other nine videos were produced by independent users. The average duration of the videos were 337.5 s, varying between 82 s and 1364 s. The average Discern score of videos produced by health professionals was 38.9 ± 13, compared to 36.6 ± 14 for independent users. The mean JAMA score was 1.04 ± 0.68 for health professionals and 1.11 ± 0.94 for independent users. The GQS score was 2.82 ± 0.73 for health professionals and 3.19 ± 0.84 for independent users. There was no statistically significant difference between the two groups for Discern, JAMA, and GQS scoring.
YouTube does not seem to be a good option for parents to get useful information about pediatric tracheostomy care at this time. Health professionals should provide websites with high-quality materials to improve awareness of pediatric tracheostomy care.
Tracheostomy care in the home
2006, Paediatric Respiratory Reviews
There are hardly any controlled studies in paediatric tracheostomy care; instead, most established standards, procedures and details have been elaborated at the bedside by trial and error. Once the appropriate tube is chosen, tube care consists of tube change, fixation, management of secretions, humidification of inspired air and application of medications. The stoma requires cleaning, protection and dressing. Child care may be structured into monitoring, feeding, bathing and clothing. Preparing the home and family environment are important prerequisites for discharge from the hospital. Last but not least, the family of the child or other caregivers must undergo a structured and detailed training programme to become competent in long-term home care.
Home ventilator low-pressure alarms fail to detect accidental decannulation with pediatric tracheostomy tubes
2001, Chest
Positive-pressure ventilators are equippedwith low-inspiratory-pressure alarms to protect patients fromhypoventilation. Small uncuffed tracheostomy tubes have a highresistance, and may not trigger these alarms during decannulation.
To determine whether ventilatorlow-inspiratory-pressure alarms are effective in detecting tracheostomydecannulation.
We connected tracheostomy tubesof varying inner diameters (3.0 to 6.0 mm) to a home ventilator andsimulated decannulation using low (tidal volume [Vt], 600mL; peak inspiratory pressure [PIP], 25 cm H₂O), medium(Vt, 800 m, L; PIP, 30 cm H₂O), and high(Vt, 1,000 m, L; PIP, 35 cm H₂O) ventilatorsettings.
When the ventilatorlow-inspiratory-pressure alarm was set at 4 cm H₂O belowthe desired PIP, it failed to alarm for simulated decannulation oftracheostomy tubes < 4.5 mm on low and medium settings, and < 4.0mm on high settings. When the ventilator low-inspiratory-pressure alarmwas set at 10 cm H₂O below the desired PIP, it failed toalarm with tracheostomy tubes < 6.0 mm.
We conclude that ventilator low-inspiratory-pressure alarms fail toalarm during simulated decannulation with small tracheostomy tubescommonly used in children. We speculate that low-inspiratory-pressurealarms set at 4 cm H₂O below the desired PIP will detectmore decannulation than when set at 10 cm H₂O below thedesired PIP.
Training paramedics: Emergency care for children with special health care needs
2000, Prehospital Emergency Care
Objective. To enhance knowledge and comfort related to the emergency care of children with special health care needs (CSHCN) through an innovative continuing education program for paramedics. Methods. A self-study program presenting in-depth information about common problems that affect the assessment and management of a child's airway, breathing, circulation, disability, and environment (ABCDEs), regardless of the child's diagnosis, was developed. This program used a manual, a video, practice mannequins, and skills evaluations to teach skills to paramedics employed at a municipal fire department. Results. Pre- and posttraining surveys found that the paramedics were significantly more comfortable with the assessment and management of CSHCN after the completion of the self-study program, with a pretraining average of 2.83 and posttraining average of 4.20 on a five-point Likert-type scale, t(37) = 12.87, p < 0.001. A skills evaluation showed that skills performance varied widely across 21 skills, ranging from skills mastery to low skills knowledge. On the posttraining survey, between 74% and 94% of the paramedics rated each topic (tracheostomies, indwelling central venous catheters, cerebrospinal fluid shunts, gastrostomies, child abuse, and latex allergy) as applicable to their practices as paramedics. Conclusion. Given the growing population of CSHCN, it is important to provide specialized education to increase an EMS provider's preparedness to respond to emergency situations involving children with special health care needs. PREHOSPITAL EMERGENCY CARE 2000;4:178-185
Parental report of pediatric tracheostomy care
1998, Archives of Physical Medicine and Rehabilitation
Objective: There are little data on the actual care given pediatric tracheostomy patients in their homes. Information on the use of supplies and on techniques and frequency of care is valuable for a better understanding of the needs of this population.
Design: Questionnaires were distributed by mail or at clinic visits from May 1995 to June 1996 to a convenience sample of tracheotomized patients at the University of Michigan Pediatric Physical Medicine and Rehabilitation clinic.
Setting: Tertiary care clinic.
Results: Clean technique for suctioning was reported by 96.7% of subjects and the rest reported sterile technique. Fifty percent of subjects reported reusing suction catheters. Cleaning solutions used to clean suction catheters for reuse varied. Tracheostomy tube reuse was reported by 55% of subjects. Sixty percent of those who reused tracheostomy tubes had had pneumonia within the previous year, whereas only 25% of those who never reused the tracheostomy tube had pneumonia in the same time period.
Conclusions: Suctioning frequency, suction catheter, and tracheostomy tube reuse and cleaning methods are variables that warrant further investigation of safety and efficacy.
Evaluating YouTube as a Source of Patient Information for Pediatric Tracheostomy Care
2023, Research Square

View all citing articles on Scopus

^☆: Presented at the 26th Annual Meeting of the Canadian Association of Paediatric Surgeons, Toronto, Ontario, September 19–21, 1994.

View full text

The safety of home tracheostomy care for children☆

Abstract

J Pediatr Surg

Int J Ped Otorhinolaryngol

Tracheostomy in children with emphasis on home care

J Pediatr Surg

Endoscopic assessment in children with tracheotomies

Arch Otolaryngol Head Neck Surg

Experience with the home-care of tracheotomised paediatric patients

Arch Otorhinolaryngol

Home care of the pediatric tracheostomy: Our experience

J Otolaryngol