Care of Pediatric Tracheostomy in the Immediate Postoperative Period and Timing the First Tube Change

Abstract

Objectives: 1) Analyze the impact of a new postoperative care protocol on complications, including skin breakdown. 2) Analyze the safety of performing the first tracheostomy tube change prior to postoperative day 5. Methods: Retrospective case series in an academic medical center. Patients: Pediatric patients undergoing tracheostomy from February 2010 to February 2013. Intervention: In 2012 a new protocol was instituted for pediatric tracheostomy care in the immediate postoperative period that included: 1) securing tracheostomy tubes with Velcro straps rather than twill ties, 2) placing a clean drain sponge around the tracheostomy tube daily, and 3) performing the first tracheostomy tube change on postoperative day 3 or 4. Outcome Measures: 1) Rate of complications, including skin breakdown, related to the tracheostomy tube and securing straps. 2) Presence of a mature stoma allowing for a safe first tracheostomy tube change. Results: 37 patients in the pre-protocol group and 16 in the post-protocol group were analyzed. Rate of skin breakdown related to the tracheostomy tube or securing straps was significantly higher in the pre-protocol group (32.40% vs. 0%, P = 0.01). There was a trend towards a higher overall complication rate change in the pre-protocol group, but this was not statistically different (18.90% vs. 0%, P = 0.062). In the post-protocol group, all tube changes were safely performed on postoperative day three or four. Conclusions: This new care protocol for pediatric tracheostomies resulted in decreased rates of skin breakdown. In addition, pediatric tracheostomy tubes can be safely changed as early as 3 days postoperatively.