The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

TRACHEOSTOMY TUBE CHANGES TO DOWNSIZE AND DECANNULATIONS ARE SAFE WHEN PERFORMED BY RESPIRATORY THERAPISTS.

Delgado Delgado, Mark Cohen-Melamed, Vince Rafeew, Phillip Matelan, Gary Largent, Raymond Tuttle; Respiratory care, University of Pittsburgh Medical Center, Pittsburgh, PA

The University of Pittsburgh Medical Center (Oakland campus) has 156 ICU beds with an average daily ventilator census of 86 and 151 full time equivalents (FTE’s). In 2004 a process was established in-order to facilitate downsizing and decannulation of all trachestomized patients. The therapists in the Cardiothoracic (CT) ICU team were chosen for this process. Patients with high acuities including those with lung transplant, heart Transplant and open heart surgery were involved in the process. Methods: Protocol for trach downsizing and decannulation procedure was developed. All Respiratory Therapists had three phases of training for the procedure, which included physician lecture, procedure demonstration using manikin and return demonstration with competency verification via manikin simulation technology. Staff were monitored for 3 procedures and then operated independently. Continuous monitoring of oxygen saturation via pulse oximetry, arterial blood pressure, heart rate, respiratory rate, breath sound and bleeding (tracheal aspirate) assessed the safety of the procedures. The therapists were responsible for monitoring the process and coordinating with the physician as per protocol to begin the downsizing and decannulation process. Data was collected and tabulated in Excel spread sheet by the lead therapist. Results: Respiratory therapists performed 333 trach change procedures and 131 decannulations on 299 patients. A total of seven (1.5%) adverse events were reported of a total of 464 combined changes and/or decannulations. In 5 (1.5%) cases Respiratory Therapists had trouble reinserting the smaller sized tube which required physician intervention. Furthermore, 2 (0.6%) cases required direct visualization utilizing a fiber optic bronchoscope due to anatomical deformity of trachea and granuloma formation. The average time from initial trach to decannulation was 35.5 + 29.7 days. Conclusions: Under order of physicians, Respiratory Therapists can perform downsizing and decannulation of Tracheostomized patients safely. Furthermore, Respiratory Therapists can act as the “gate keeper” for process of downsizing and decannulating tracheostomy patients. Sponsored Research - None