854 Paediatric Tracheostomy Decannulation: An Updated Protocol at Nottingham University Hospitals (NUH)

Abstract

Abstract Introduction Tracheostomy decannulation is an extremely important part of tracheostomy care in paediatric patients. Due to the increased risk of morbidity1 (bleeding, respiratory infection, airway plugging, accidental decannulation) and mortality2 (0.5-3.6%) associated with prolonged tracheostomies, it is strongly advised to decannulate the paediatric patient as soon as the underlying cause for tracheostomy placement is corrected or resolved3. A simple to navigate protocol is required in order to establish a safe and efficient way of decannulation as well as knowing when and how to decannulate. The literature varies widely in regard to an optimal method and the process leading to decannulation can often be different for each individual patient; as such, this may require review on a case-by-case basis. Protocol We have developed an NUH specific protocol in the format of a flow chart to act as a guideline in successfully decannulating paediatric tracheostomies. It provides the foundations in assessing each paediatric patient’s clinical readiness and subsequent progression of decannulation. We have incorporated Mitchell et al’s 2013 clinical consensus statement on tracheostomy care as the primary resource for the creation of this protocol. It is suitable for any member of staff looking after paediatric patients with tracheostomies, whether they be situated on a paediatric ward, PHDU or PICU. In addition to care from parent teams and nursing staff, it is important for each paediatric tracheostomy patient to have input from the long-term ventilation (LTV) team who can offer support in the timing and progression of decannulation.