Assessment of Healthcare Professionals' Knowledge
Background: Ear, nose, and throat (ENT) surgeons perform the majority of surgical tracheostomies. Intensive care anaesthetists are increasingly performing bedside percutaneous tracheostomy. The objectives of this study were to characterize emergency complications of tracheostomy and to ascertain healthcare professionals' knowledge of life-saving strategies for the patient with a tracheostomy.
Methods: Seventy staff members in two large teaching hospitals completed an interview questionnaire, comprising a simple clinical scenario and unambiguous questions regarding the emergency management of patients with a tracheostomy.
Results: There were significant gaps in knowledge among healthcare professionals regarding the management of specific tracheostomy-related emergencies.
Conclusions: Knowledge of tracheostomy-related emergencies appears to be insufficient among non-ENT healthcare professionals. This needs to be addressed in order to maximize patient safety.
Tracheostomy is among the most commonly conducted procedures in critically ill patients. It is performed predominantly in patients who require prolonged mechanical ventilation, frequent suctioning for broncho-pulmonary toilet, or have obstruction of the upper airway. The indications for the procedure have evolved with the ability to keep critically ill patients alive, such that two-thirds of tracheostomies are performed on patients who are in the intensive care unit (ICU).
There are two approaches to tracheostomy: open surgical tracheotomy (ST) and percutaneous dilatational tracheostomy (PT). ST has traditionally been undertaken by ear, nose, and throat (ENT) (otorhinolaryngeology) surgeons. With the increasing use of PT, a wider range of healthcare providers are now directly involved in the care of patients with a tracheostomy and need to be familiar not only with tracheostomy care, but also with the techniques of decannulation and management of acute and life-threatening complications.
Tracheostomy tube displacement, regardless of the operative technique used, may occur at any time. Although uncommon, such displacement is potentially serious and can be life threatening. When replacement is required under emergency conditions, the procedure can be difficult, particularly if this occurs early before a tract has had time to form. Multiple factors including obesity, short neck, abnormal anatomy, copious respiratory tract secretions, and excessive granulation tissue can complicate the replacement of a stable airway. Blind, forceful attempts at tracheostomy tube re-insertion in the early postoperative period can result in the creation of a false passage and possible respiratory arrest. If accidental decannulation occurs before the tract has time to form, then oral tracheal intubation should be performed if possible.
The use of stay sutures placed circumferentially around the tracheal rings has been proposed. In our centres, stay sutures are routinely used for ST. These sutures are cut long and left out of the wound and then taped to the anterior chest wall. They can be of help during the operation and can be of benefit after it. If the tube is displaced from the trachea in the early postoperative period, traction on these sutures can permit rapid re-intubation.
With a wider range of healthcare professionals now directly involved in managing patients with a tracheostomy, we sought to evaluate their knowledge regarding life-threatening emergencies and to identify key areas in which appropriate management strategies are inadequate.
Abstract and Introduction
Abstract
Background: Ear, nose, and throat (ENT) surgeons perform the majority of surgical tracheostomies. Intensive care anaesthetists are increasingly performing bedside percutaneous tracheostomy. The objectives of this study were to characterize emergency complications of tracheostomy and to ascertain healthcare professionals' knowledge of life-saving strategies for the patient with a tracheostomy.
Methods: Seventy staff members in two large teaching hospitals completed an interview questionnaire, comprising a simple clinical scenario and unambiguous questions regarding the emergency management of patients with a tracheostomy.
Results: There were significant gaps in knowledge among healthcare professionals regarding the management of specific tracheostomy-related emergencies.
Conclusions: Knowledge of tracheostomy-related emergencies appears to be insufficient among non-ENT healthcare professionals. This needs to be addressed in order to maximize patient safety.
Introduction
Tracheostomy is among the most commonly conducted procedures in critically ill patients. It is performed predominantly in patients who require prolonged mechanical ventilation, frequent suctioning for broncho-pulmonary toilet, or have obstruction of the upper airway. The indications for the procedure have evolved with the ability to keep critically ill patients alive, such that two-thirds of tracheostomies are performed on patients who are in the intensive care unit (ICU).
There are two approaches to tracheostomy: open surgical tracheotomy (ST) and percutaneous dilatational tracheostomy (PT). ST has traditionally been undertaken by ear, nose, and throat (ENT) (otorhinolaryngeology) surgeons. With the increasing use of PT, a wider range of healthcare providers are now directly involved in the care of patients with a tracheostomy and need to be familiar not only with tracheostomy care, but also with the techniques of decannulation and management of acute and life-threatening complications.
Tracheostomy tube displacement, regardless of the operative technique used, may occur at any time. Although uncommon, such displacement is potentially serious and can be life threatening. When replacement is required under emergency conditions, the procedure can be difficult, particularly if this occurs early before a tract has had time to form. Multiple factors including obesity, short neck, abnormal anatomy, copious respiratory tract secretions, and excessive granulation tissue can complicate the replacement of a stable airway. Blind, forceful attempts at tracheostomy tube re-insertion in the early postoperative period can result in the creation of a false passage and possible respiratory arrest. If accidental decannulation occurs before the tract has time to form, then oral tracheal intubation should be performed if possible.
The use of stay sutures placed circumferentially around the tracheal rings has been proposed. In our centres, stay sutures are routinely used for ST. These sutures are cut long and left out of the wound and then taped to the anterior chest wall. They can be of help during the operation and can be of benefit after it. If the tube is displaced from the trachea in the early postoperative period, traction on these sutures can permit rapid re-intubation.
With a wider range of healthcare professionals now directly involved in managing patients with a tracheostomy, we sought to evaluate their knowledge regarding life-threatening emergencies and to identify key areas in which appropriate management strategies are inadequate.
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