The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

BESIDE PERCUTANEOUS DILATATIONAL TRACHEOSTOMY- RESPIRATORY CARE PRACTITIONER INVOLVEMENT

Steve DesJardins RRT, Sally Whitten RRT Maine Medical Center, Portland, Maine

INTRODUCTION: Patients requiring long term mechanical ventilatory care may benefit from a tracheostomy. Beside Percutaneous Dilatational Tracheostomy (BPDT) has been shown to be safe, quick, convenient and cost effective. Additionally, the length of stay in the intensive care unit (ICU) has been decreased. According to Rodriquez et al, "early tracheostomy decreases dependency on the ventilator". Patient comfort and ease of care for the airway was improved. All patients required mechanical ventilatory support for respiratory insufficiency. BPDT procedures were performed at the patients bedside in the ICU. A respiratory care practitioner (R.C.P.) was present for each procedure. METHOD: BPDT was performed on forty-eight patients in our multi-disciplinary ICU. The pilot study was from January of 1995 to January of 1996. BPDT procedures were performed by a staff surgeon and assisted by a respiratory therapist and an ICU nurse without the presence of an anesthesiologist. The nurse was responsible for the sedation and general care of the patient during the procedure. The R.C.P. was responsible for maintaining the airway during and after the procedure. The therapist advances the ET tube (to prevent rupture of ET cuff) and eventually extubates the patient when the tracheostomy tube is inserted. Additionally, the R.C.P. monitors the patients end-tidal (ETCO_{2}) to assure proper placement of the tracheostomy tube and monitors the patients SpO_{2} in assure adequate oxygenation. Results: Patients undergoing BPDT suffered from a variety of illnesses. Of the 48 patients, two had ETT cuffs rupture during insertion of the 18-gauge needle for tracheal access. These two cases did not experience any further complications. Due to the small incision and the vasoconstrictive properties of lidocaine, blood loss was minimal. Tracheostomy wound infection was not seen nor were any of the 48 patients sent to the OR for BPDT related issues. BPDT eliminates the need for consumption of OR resources and personnel as well as the risk of transporting these critically ill patients. The cost benefit to the patient was considered to be substantial, standard tracheostomy performed in the OR with the assistance of anesthesiologist was $2642. The cost for BPDT performed in the ICU utilizing R.C.P.'S and ICU nurses was $997, representing a cost savings of $1645. Conclusions: We find doing BPDT in the ICU to be safe, cost effective and may decrease the length of stay in the ICU. BPDT procedure average duration was 15-20 minutes. Involvement in BPDT offers benefits for the RCP that include role expansion and more direct involvement in patient care. Patients benefit from decreased cost and potentially decreased ICU length of stay.

Reference: OF-96-005

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