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Long-Term Tracheostomy: Outcome, Cannula care, and Material Wear
Sophiahemmet University.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Do people with long-term tracheostomy need hospital care? Which cleaning method is most appropriate for decontamination of inner cannulae? Are tracheostomy tubes changed for rational reasons? There is clearly a lack of evidence based research in this field and the clinical guidelines available are often based on local practice. A tracheostomy is a created opening in trachea to facilitate breathing. It is a direct entry to the deeper airways, e.g. for micro-organisms causing a potential risk for lung infections. Indications for long-term tracheostomy can be, e.g. upper airway obstruction, malformations, or chronic hypoventilation, when ventilation via nasal mask is not possible. The research of the present thesis was conducted at the National Respiratory Centre (NRC) at Danderyd Hospital in Stockholm, Sweden. This unit opened in 1982, with the expressed goal of supporting outpatients with long-term tracheostomy. The overall aims of the thesis were to evaluate the outcome of patients with long-term tracheostomy and to conduct evidence based studies concerning their care.

A comparison was made for the number of days in hospital care during the 2-year periods before and after the tracheostomy was established. The life expectancy of the general population and the observed life span of a cohort of tracheostomized patients from the start of NRC in 1982 were also compared. Interestingly enough, the need for hospital care was unchanged despite of the tracheostomy. The patients’ observed life spans were remarkably high and for many patients not lower than the life expectancy of Swedish people in general.

To find a practical and safe decontamination method for inner cannulae we compared two different cleaning methods; detergent followed by chlorhexidine-alcohol, or detergent alone. Samples for bacterial culture were taken before and after cleaning and the numbers of bacteria colonies were counted. The effectiveness of both cleaning methods was greater than expected and the results showed a nearly total elimination of organisms. Thus, the methods investigated were equivalent in achieving decontamination.

The duration of use in our unit for polymeric tracheostomy tubes, i.e. silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) was determined and compared. We found, that Si tubes were used for longer periods (three months) than tubes made of PU or PVC (both two months).

Whether or not surface changes could be observed on the tracheostomy tubes after 30 days’, three and six months’ exposure in the trachea were investigated in collaboration with the Royal Institute of Technology and Sophiahemmet University College in Stockholm, Sweden. The analyzing methods were Scanning Electron Microscopy, Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy, and Differential Scanning Calorimetry. All tubes, except one, showed changes in the surface after 30 days’ exposure. The surface changes had progressed significantly after three and six months' exposure, compared to the changes detected after 30 days. The SF-36 questionnaire and a study specific questionnaire were used to describe the patients’ health-related quality of life and experiences of long-term tracheostomy. The results show that all patients were satisfied with their tracheostomy and demonstrated a numerically mean mental health status score above that of the general population.

In summary, long-term tracheostomy does not increase the need for hospital care nor does it reduce a patient’s life span. Cleaning the tracheostomy inner cannula with detergent and water is sufficient to achieve decontamination. Si tracheostomy tubes are used longer compared to those made of PVC or PU. The polymeric material investigated suffered evident surface changes after 30 days’ use. Clinical use of polymeric tracheostomy tubes beyond three months cannot be recommended, as we found extensive surface changes and degradation of the polymeric chains. All patients were, in general content, with their tracheostomy. The findings from the present thesis contribute to making the care of long-term tracheostomized patients’ evidence based.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2007. , 66 p.
Keyword [en]
Long-term tracheostomy, Respiratory failure, Hospital care, Tracheostomy care, Decontamination, Trachestomy tube, Material degradation, Polymeric material, Health-related quality of life
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-134ISBN: 978-91-7357-261-3 (print)OAI: oai:DiVA.org:shh-134DiVA: diva2:314372
Public defence
2007-10-12, 09:00 (English)
Opponent
Supervisors
Available from: 2010-04-27 Created: 2010-03-09 Last updated: 2016-06-09Bibliographically approved
List of papers
1. Material wear of polymeric tracheostomy tubes: a six-month study
Open this publication in new window or tab >>Material wear of polymeric tracheostomy tubes: a six-month study
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2009 (English)In: The Laryngoscope, ISSN 1531-4995, Vol. 119, no 4, 657-64 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objectives were to study long-term material wear of tracheostomy tubes made of silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) after 3 and 6 months of clinical use. STUDY DESIGN: The study has a prospective and comparative design. METHODS: Nineteen patients with long-term tracheostomy, attending the National Respiratory Center in Sweden, were included, n = 6 with Si tubes, n = 8 with PVC tubes, and n = 5 with PU tubes. The tubes were exposed to the local environment in the trachea for 3 and 6 months and analyzed by scanning electron microscopy, attenuated total reflectance Fourier transform infrared spectroscopy, and differential scanning calorimetry. RESULTS: All tubes revealed severe surface changes. No significant differences were established after 3 or 6 months of exposure between the various materials. The changes had progressed significantly after this period, compared to previously reported changes after 30 days of exposure. The results from all analyzing techniques correlated well. CONCLUSIONS: All tubes, exposed in the trachea for 3-6 months, revealed major degradation and changes in the surface of the material. Polymeric tracheostomy tubes should be changed before the end of 3 months of clinical use.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-20 (URN)10.1002/lary.20048 (DOI)19205021 (PubMedID)
Available from: 2010-03-04 Created: 2010-02-22 Last updated: 2014-09-29Bibliographically approved
2. Clinical use and material wear of polymeric tracheostomy tubes
Open this publication in new window or tab >>Clinical use and material wear of polymeric tracheostomy tubes
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2007 (English)In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 117, no 9, 1552-9 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objectives were to compare the duration of use of polymeric tracheostomy tubes, i.e., silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU), and to determine whether surface changes in the materials could be observed after 30 days of patient use. METHODS: Data were collected from patient and technical records for all tracheostomized patients attending the National Respiratory Center in Sweden. In the surface study, 19 patients with long-term tracheostomy were included: six with Bivona TTS Si tubes, eight with Shiley PVC tubes, and five with Trachoe Twist PU tubes. All tubes were exposed in the trachea for 30 days before being analyzed by scanning electron microscopy (SEM) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR). New tubes and tubes exposed in phosphate-buffered saline were used as reference. RESULTS: Si tubes are used for longer periods of time than those made of PVC (P<.0001) and PU (P=.021). In general, all polymeric tubes were used longer than the recommended 30-day period. Eighteen of the 19 tubes exposed in patients demonstrated, in one or more areas of the tube, evident surface changes. The morphologic changes identified by SEM correlate well with the results obtained by ATR-FTIR. CONCLUSIONS: Si tracheostomy tubes are in general used longer than those made of PVC and PU. Most of the tubes exposed in the trachea for 30 days suffered evident surface changes, with degradation of the polymeric chains as a result.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-22 (URN)10.1097/MLG.0b013e31806911e3 (DOI)17632426 (PubMedID)
Available from: 2010-03-04 Created: 2010-02-22 Last updated: 2014-09-29Bibliographically approved
3. Tracheostomy inner cannula care: a randomized crossover study of two decontamination procedures
Open this publication in new window or tab >>Tracheostomy inner cannula care: a randomized crossover study of two decontamination procedures
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2007 (English)In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 35, no 9, 600-5 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Today several methods for decontaminating inner cannulae exist. These methods are not based on scientific data, but often on local clinical tradition. This study compares two different decontamination methods. The aim was to find a practical and safe decontamination method. It is a randomized, single-blinded, comparative crossover study. METHODS: Fifty outpatients with long-term tracheostomy with an inner cannula were consecutively included and randomly allocated to begin with one of two different treatment sequences: detergent and chlorhexidine-alcohol (A) or detergent (B). Samples for bacterial culture were taken before and after decontamination, and the number of bacteria colonies was counted. RESULTS: Before decontamination, the inner cannulae grew high numbers of bacteria, which were parts of the normal flora of the upper respiratory tract and did not differ significantly between the two sequences (AB; BA). The primary variable was the culture count value after chlorhexidine-alcohol/detergent (A) and detergent (B). The effects of both methods were larger than expected, and the results showed a nearly total elimination of organisms. The equivalence criterion, ratio of mean colony counts (A/B) >0.8, was met at a significance level of P<0.001. CONCLUSIONS: Cleaning the tracheostomy inner cannula with detergent and water is sufficient to achieve decontamination.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-21 (URN)10.1016/j.ajic.2006.11.006 (DOI)17980239 (PubMedID)
Available from: 2010-03-04 Created: 2010-02-22 Last updated: 2014-09-29Bibliographically approved
4. A retrospective survey of outpatients with long-term tracheostomy
Open this publication in new window or tab >>A retrospective survey of outpatients with long-term tracheostomy
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2006 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 4, 399-406 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Respiratory Unit (RU) at Danderyd University Hospital opened in 1982, with the expressed goal of supporting outpatients with long-term tracheostomy. The primary aim of this retrospective study in tracheostomized patients was to compare the need for hospital care in the 2-year period before and after the tracheostomy. METHODS: Data were collected from patient medical records at the RU, from the National Board of Health and Welfare, Sweden and from the Official Statistics of Sweden. The subjects were RU patients in 1982 (Group 1, n = 27) and in 1997 (Group 2, n = 106) with long-term tracheostomy surviving at least 4 years after the tracheostomy. RESULTS: Both groups had few and unchanged needs for hospital care after tracheostomy. They spent > or = 96% of their time out of hospital. In 1997, (group 2) the number of patients, diagnoses and need for home mechanical ventilation had increased. Life expectancy was assessed for patients in Group 1. Data showed that they lived as long as an age-matched and gender-adjusted control cohort. CONCLUSIONS: Long-term tracheostomy may not increase the need for hospital care and does not reduce life expectancy. These clinical observations were made in a setting where patients had regular access to a dedicated outpatient unit.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-23 (URN)10.1111/j.1399-6576.2005.00939.x (DOI)16548851 (PubMedID)
Available from: 2010-03-04 Created: 2010-02-22 Last updated: 2014-09-29Bibliographically approved

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