The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

CHANGING TRACHEOSTOMY TUBE MATERIAL AND UTILIZING SILICONE DRESSINGS HEALED THIS STOMA - A CASE STUDY.

Linda K. Dean; Respiratory Therapy, Fauquier Hospital, Rixeyville, VA

Introduction: Tracheostomy tubes are made of a variety of materials: plastic, silicone, stainless steel. Chronic wound infections and misshapen stomas are a complication of prolonged tracheostomy. Our goal was to see if a change in tracheostomy tube material in conjunction with stabilizing the tube could improve the condition of this stoma. History: 52 year old male with diagnosis of MS decompensated requiring tracheostomy and prolonged mechanical ventilation. A number 6 Shiley™ tracheostomy tube was inserted. Over time, the stoma enlarged and the site was a constant source of infection; red, irritated skin at the stoma site, copious foul smelling secretions, and bad breath. Routine 30 day tube change showed a black moldy substance on the shaft of the tube. The weight and constant movement of the ventilator circuit caused the stoma to become enlarged and misshapen; the cuff could be seen. The decision was made to place a 6 Shiley XLT tube with increased distal length to better seal the airway for mechanical ventilation. This patient weaned from the ventilator, but remained tracheostomized secondary to his weakened neuromuscular state. The stoma site continued to be a challenging wound, so the decision was made to change tube material and stabilize the tube. Objective: Our goal was to see if a change in tracheostomy tube material in conjunction with stabilizing the tube could improve the condition of this stoma. Methods: #8 Bivona® TTS silicone tube was inserted and stabilized with a Sil.Flex® TC Pad. This silicone pad was applied under the flange. Nothing else was changed in regards to his routine trach care or oral care. Results: Within 3 days the foul smell was gone, secretions had cleared, and the mucosa became a normal pink color. There was evidence of new healthy skin growth around the stoma. The patient noted less movement of the tube immediately and greater comfort. Other benefits noted were: increased SaO2, skin tone/color and LOC. After one month routine tube change revealed a remarkably clean shaft of the tube; inside and out. Conclusion: This single patient case study demonstrated significant improvement in the tracheostomy stoma site when the tube material was changed to silicone and stabilized with the Sil.Flex TC Pad. Sponsored Research - None