Tracheostomy: care and management r

Tracheostomy: care and management review
These guidelines are intended to support practitioners caring for children/young people with a Tracheostomy.
Quick reference algorithms are included in these guidelines for practitioner use.
Living with a Tracheostomy and National Tracheostomy Safety Project are useful resources.
Section 1. Formation and care of a NEW Tracheostomy
Preparation of equipment and environment - Care of the New Tracheostomy (less than 7 days)
Initial care - Care of the New Tracheostomy (less than 7 days
Early post insertion complications
Section 2. Management- ‘TRACHE’ bundle
T apes: Keep the tracheostomy tube secure
R esus/ Emergency Care: know the resuscitation procedure
A irway Clear: Use the correct suction technique
C are of the Stoma and neck
H umidity: essential to keep tube clear
E mergency equipment: have the box present
Tube changes: planned
Section 3. Specific Information;
Carer competency guide and Discharge planning
General information on tracheostomy tubes
Background
More children with chronic medical conditions are surviving, largely due to advances in tracheostomy care and technology support. The vast majority of these children are now being cared for in their own homes and at school.
Surgical tracheostomy in the paediatric population is indicated when a safe, protected airway is required in the long term. However, as with all surgical procedures, it is associated with risks and complications. Morbidity and mortality rates reported in Tracheostomy in Paediatrics carries a 2-3 times higher morbidity and mortality than is in adults (Alladi A, Rao S, et al, 2004). The overall mortality rate for a complication directly related to a paediatric tracheostomy is 0.7% (Carr M.M, Poje CP, et al, 1995-1998). The majority of reported adverse incidents do not occur in the immediate post-operative period, late complications occurring a week or more from the date of insertion are four times more common (Corbett HJ, Mann KS, et al. 2007). Therefore, consistent high quality tracheostomy care is essential and must be delivered by all those caring for these children in both the hospital and community environments. Establishing training in the management of paediatric tracheostomy which is based on formalised standards would improve the consistency and quality of care.
Currently, there are no formally accepted national standards in the United Kingdom (UK) for paediatric tracheostomy management. Tracheostomy management has been the focus of a number of reviews in the UK over the last decade; however, paediatric patients have thus far been excluded from the analysis (Thomas AN and McGrath BA. (2009) National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2014). As a tertiary paediatriccentre, Great Ormond Street Hospital (GOSH) carries out approximately 70-90 tracheostomies per annum, with approximately 2000 being managed by the department as a whole. The author of this guideline has participated in the National Tracheostomy Safety Project and has collaborated widely with the key stakeholders in tracheostomy care and developed guidance by consensus. These resources are supported by local algorithms and podcasts which are linked to this document. For further info, please see the Paediatric section in Comprehensive Tracheostomy Care - The National Tracheostomy Safety Project manual (McGrath 2014)
A tracheostomy is an artificial opening in the trachea, usually between the 2nd and 4th tracheal rings, (depending on the size / anatomy of the child, see Figure 1), through which a tube is inserted to facilitate breathing. A tracheostomy can be a lifesaving operation but is also a life threatening one unless the airway is cared for appropriately and kept clear from secretions and blockages 24 hours a day.
Children with tracheostomies require constant supervision from those fully trained in its care.
ZOOM
Section 1: Formation and care of a NEW Tracheostomy
Preparation of equipment and environment - Care of the New Tracheostomy (less than 7 days)
Appropriate resuscitation and suction equipment and correct size face mask in full working order should be available as well as a 15mm Smiths Medical (Portex©) swivel connector (Rationale 1).
In addition flat-ended tubes such as Sheffield silver, GOS, Portex, require an appropriately sized tracheal tube adapter and a Smiths Medical (Portex©) swivel connector. This creates a 15mm termination that will be compatible with all resuscitation and ventilator equipment. Advice can be sought from the Tracheostomy Nurse Practitioner (TNP) or the Ear Nose and Throat (ENT) team.
A multi-disciplinary team discussion between Tertiary Paediatric hospitals led to the development of an updated (Hospital) Paediatric tracheostomy emergency algorithm (see page 1 and 2 of appendix 1).
A bed head notice (see page 1 of appendix 1) completed by the ENT Surgeons or TNP must be placed on the child young person’s cot/bed.
A Bed Head Hospital Resuscitation Algorithm

ผลลัพธ์ (ไทย) 1:

Tracheostomy: ดูแลและจัดการรีวิวแนวทางเหล่านี้มีวัตถุประสงค์เพื่อสนับสนุนผู้ดูแลสำหรับเด็ก/หนุ่ม Tracheostomy เป็น อัลกอริทึมอ้างอิงด่วนตั้งอยู่ในแนวทางเหล่านี้เพื่อใช้ประกอบการ นั่งเล่น ด้วย Tracheostomy และโครงการความปลอดภัย Tracheostomy ชาติมีประโยชน์ ส่วนที่ 1 สร้างและดูแล Tracheostomy ใหม่การเตรียมอุปกรณ์และสภาพแวดล้อมในการทำงานดูแล Tracheostomy ใหม่ (ไม่เกิน 7 วัน)การดูแลเบื้องต้น - ดูแล Tracheostomy ใหม่ (ไม่เกิน 7 วันก่อนโพสต์แทรกแทรกซ้อนส่วนที่ 2 จัดการ 'TRACHE' กลุ่มลิง T: ให้หลอด tracheostomy ปลอดภัยR esus / ดูแลฉุกเฉิน: รู้ตอนชีพIrway ล้าง: ใช้เทคนิคการดูดที่ถูกต้องC มีปากใบและลำคอH umidity: จำเป็นเพื่อให้หลอดใสอุปกรณ์ mergency E: มีกล่องอยู่หลอดเปลี่ยนแปลง: การวางแผน ส่วนที่ 3 ข้อมูลแนะนำความสามารถด้านคุมออกซิเจนและปล่อยวางข้อมูลทั่วไปเกี่ยวกับหลอด tracheostomyพื้นหลังเด็ก มีโรคเรื้อรังอยู่รอด มากเนื่องจากความก้าวหน้าในการสนับสนุนดูแลและเทคโนโลยี tracheostomy เด็กเหล่านี้ส่วนใหญ่จะเดี๋ยวนี้ถูกแลอย่าง ในบ้านของตนเอง และ ที่โรงเรียนSurgical tracheostomy in the paediatric population is indicated when a safe, protected airway is required in the long term. However, as with all surgical procedures, it is associated with risks and complications. Morbidity and mortality rates reported in Tracheostomy in Paediatrics carries a 2-3 times higher morbidity and mortality than is in adults (Alladi A, Rao S, et al, 2004). The overall mortality rate for a complication directly related to a paediatric tracheostomy is 0.7% (Carr M.M, Poje CP, et al, 1995-1998). The majority of reported adverse incidents do not occur in the immediate post-operative period, late complications occurring a week or more from the date of insertion are four times more common (Corbett HJ, Mann KS, et al. 2007). Therefore, consistent high quality tracheostomy care is essential and must be delivered by all those caring for these children in both the hospital and community environments. Establishing training in the management of paediatric tracheostomy which is based on formalised standards would improve the consistency and quality of care. Currently, there are no formally accepted national standards in the United Kingdom (UK) for paediatric tracheostomy management. Tracheostomy management has been the focus of a number of reviews in the UK over the last decade; however, paediatric patients have thus far been excluded from the analysis (Thomas AN and McGrath BA. (2009) National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2014). As a tertiary paediatriccentre, Great Ormond Street Hospital (GOSH) carries out approximately 70-90 tracheostomies per annum, with approximately 2000 being managed by the department as a whole. The author of this guideline has participated in the National Tracheostomy Safety Project and has collaborated widely with the key stakeholders in tracheostomy care and developed guidance by consensus. These resources are supported by local algorithms and podcasts which are linked to this document. For further info, please see the Paediatric section in Comprehensive Tracheostomy Care - The National Tracheostomy Safety Project manual (McGrath 2014)A tracheostomy is an artificial opening in the trachea, usually between the 2nd and 4th tracheal rings, (depending on the size / anatomy of the child, see Figure 1), through which a tube is inserted to facilitate breathing. A tracheostomy can be a lifesaving operation but is also a life threatening one unless the airway is cared for appropriately and kept clear from secretions and blockages 24 hours a day. Children with tracheostomies require constant supervision from those fully trained in its care.
ZOOM
Section 1: Formation and care of a NEW Tracheostomy
Preparation of equipment and environment - Care of the New Tracheostomy (less than 7 days)
Appropriate resuscitation and suction equipment and correct size face mask in full working order should be available as well as a 15mm Smiths Medical (Portex©) swivel connector (Rationale 1).
In addition flat-ended tubes such as Sheffield silver, GOS, Portex, require an appropriately sized tracheal tube adapter and a Smiths Medical (Portex©) swivel connector. This creates a 15mm termination that will be compatible with all resuscitation and ventilator equipment. Advice can be sought from the Tracheostomy Nurse Practitioner (TNP) or the Ear Nose and Throat (ENT) team.
A multi-disciplinary team discussion between Tertiary Paediatric hospitals led to the development of an updated (Hospital) Paediatric tracheostomy emergency algorithm (see page 1 and 2 of appendix 1).
A bed head notice (see page 1 of appendix 1) completed by the ENT Surgeons or TNP must be placed on the child young person’s cot/bed.
A Bed Head Hospital Resuscitation Algorithm

ผลลัพธ์ (ไทย) 3:

คนถูกสร้างขึ้นเพื่อเป็นที่รัก เป็นสิ่งที่สร้างขึ้นเพื่อใช้ . . . . . . . ทางที่ผมเห็นมัน เหตุผลที่โลกสับสนวุ่นวาย เพราะสิ่งที่ถูกรัก และคนที่ถูกใช้ ! !