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Lambert EM, Ramaswamy U, Gowda SH, Spielberg DR, Hagan JL, Xiao E, Liu S, Villafranco N, Raynor T, Baijal RG. Perioperative and Long-Term Outcomes in Infants Undergoing a Tracheostomy from a Neonatal Intensive Care Unit. Laryngoscope 2024; 134:1945-1954. [PMID: 37767870 DOI: 10.1002/lary.31058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE The purpose of this study was to identify risk factors for perioperative complications and long-term morbidity in infants from the neonatal intensive care unit (NICU) presenting for a tracheostomy. METHODS This single-center retrospective cohort study included infants in the NICU presenting for a tracheostomy from August 2011 to December 2019. Primary outcomes were categorized as either a perioperative complication or long-term morbidity. A severe perioperative complication was defined as having either (1) an intraoperative cardiopulmonary arrest, (2) an intraoperative death, (3) a postoperative cardiopulmonary arrest within 30 days of the procedure, or (4) a postoperative death within 30 days of the procedure. Long-term morbidities included (1) the need for gastrostomy tube placement within the tracheostomy hospitalization and (2) the need for diuretic therapy, pulmonary hypertensive therapy, oxygen, or mechanical ventilation at 12 and 24 months following the tracheostomy. RESULTS One-hundred eighty-three children underwent a tracheostomy. The mean age at tracheostomy was 16.9 weeks while the mean post-conceptual age at tracheostomy was 49.7 weeks. The incidence of severe perioperative complications was 4.4% (n = 8) with the number of pulmonary hypertension medication classes preoperatively (OR: 3.64, 95% CI: (1.44-8.94), p = 0.005) as a significant risk factor. Approximately 81% of children additionally had a gastrostomy tube placed at the time of the tracheostomy, and 62% were ventilator-dependent 2 years following their tracheostomy. CONCLUSION Our study provides critical perioperative complications and long-term morbidity data to neonatologists, pediatricians, surgeons, anesthesiologists, and families in the expected course of infants from the NICU presenting for a tracheostomy. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1945-1954, 2024.
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Affiliation(s)
- Elton M Lambert
- Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Uma Ramaswamy
- Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Sharada H Gowda
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - David R Spielberg
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Joseph L Hagan
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Emily Xiao
- Baylor College of Medicine, Houston, Texas, U.S.A
| | - Sean Liu
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Natalie Villafranco
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Tiffany Raynor
- Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Rahul G Baijal
- Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
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Kawar L, Clark E, Kubba H. External peri-stomal skin granulations in paediatric tracheostomy: Incidence, outcomes and a proposed treatment algorithm. Int J Pediatr Otorhinolaryngol 2024; 176:111821. [PMID: 38147731 DOI: 10.1016/j.ijporl.2023.111821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND External peri-stomal skin granulations after tracheostomy in children are common and may interfere with routine tube changes. This study is the first attempt to describe the incidence and outcomes, along with a proposed treatment algorithm. METHODS A retrospective review of all inpatient children with a tracheostomy between January 2020 and May 2022 at the Royal Hospital for Children (RHC) in Glasgow. The presence of external peri-stomal granulation, date of onset and resolution, recurrence and treatment modalities were noted. All tracheostomy tubes used during the study period were made of silicone. RESULTS A total of 50 episodes of peri-stomal granulation were identified in 27 children (52 %). Median age at the end of the study period was 4.3 years, with younger children experiencing more frequent granulation. 3 episodes interfered with tracheostomy tube changes. Time to resolution of the granulation was significantly longer with topical steroid/antimicrobial ointment monotherapy, but recurrence was less common when this was used a first treatment modality. CONCLUSION Non-invasive measures such as topical anti-microbials should be used in the first instance when managing external stoma-site granulations. More invasive measures, such as silver nitrate cautery and surgical excision, should be considered if the granulation tissue is not improving or when it poses a risk to safe tube changes.
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Affiliation(s)
- Luai Kawar
- University College Hospital, 235 Euston Road, London NW1 2BU, England, UK.
| | - Emma Clark
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
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Mirza B, Marouf A, Abi Sheffah F, Marghlani O, Heaphy J, Alherabi A, Zawawi F, Alnoury I, Al-Khatib T. Factors influencing quality of life in children with tracheostomy with emphasis on home care visits: a multi-centre investigation. J Laryngol Otol 2023; 137:1102-1109. [PMID: 36089743 DOI: 10.1017/s002221512200202x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Only a few studies have assessed the quality of life in children with tracheostomies. This study aimed to evaluate the quality of life and the factors influencing it in these children. METHOD This cross-sectional, two-centre study was conducted on paediatric patients living in the community with a tracheostomy by using the Pediatric Quality of Life Inventory. Clinical and demographic information of patients, as well as parents' socioeconomic factors, were obtained. RESULTS A total of 53 patients met our inclusion criteria, and their parents agreed to participate. The mean age of patients was 6.85 years, and 21 patients were ventilator-dependent. The total paediatric health-related quality of life score was 59.28, and the family impact score was 68.49. In non-ventilator-dependent patients, multivariate analyses indicated that social functioning and health-related quality of life were negatively affected by the duration of tracheostomy. The Quality of Life of ventilator-dependent patients was influenced by care visits and the presence of pulmonary co-morbidities. CONCLUSION Children with tracheostomies have a lower quality of life than healthy children do. Routine care visits by a respiratory therapist and nurses yielded significantly improved quality of life in ventilator-dependent children.
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Affiliation(s)
- B Mirza
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - A Marouf
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
| | - F Abi Sheffah
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
| | - O Marghlani
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - J Heaphy
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
| | - A Alherabi
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - F Zawawi
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - I Alnoury
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - T Al-Khatib
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
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Duymaz YK, Şahin Ş, Erkmen B, Uzar T, Önder S. Evaluating YouTube as a source of patient information for pediatric tracheostomy care. Int J Pediatr Otorhinolaryngol 2023; 171:111580. [PMID: 37336021 DOI: 10.1016/j.ijporl.2023.111580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To evaluate YouTube's usefulness as a source of information concerning pediatric tracheostomy care. MATERIALS AND METHODS On August 10, 2022, the top 50 YouTube search results for "pediatric tracheostomy care" were displayed. Each video was evaluated by a jury of three otolaryngologists with at least 2 years of professional experience in pediatric otolaryngology using DISCERN, scoring system of Journal of the American Medical Association (JAMA), and the Global Quality Score (GQS). RESULTS After exclusion criteria 24 videos were evaluated. Fifteen of the evaluated videos were produced by health professionals, and the other nine videos were produced by independent users. The average duration of the videos were 337.5 s, varying between 82 s and 1364 s. The average Discern score of videos produced by health professionals was 38.9 ± 13, compared to 36.6 ± 14 for independent users. The mean JAMA score was 1.04 ± 0.68 for health professionals and 1.11 ± 0.94 for independent users. The GQS score was 2.82 ± 0.73 for health professionals and 3.19 ± 0.84 for independent users. There was no statistically significant difference between the two groups for Discern, JAMA, and GQS scoring. CONCLUSION YouTube does not seem to be a good option for parents to get useful information about pediatric tracheostomy care at this time. Health professionals should provide websites with high-quality materials to improve awareness of pediatric tracheostomy care.
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Affiliation(s)
- Yasar Kemal Duymaz
- University of Health Sciences, Umraniye Training and Research Hospital, Department of Otolaryngology, Istanbul, Turkey.
| | | | - Burak Erkmen
- University of Health Sciences, Sancaktepe Martyr Prof Dr Ilhan Varank Training and Research Hospital Department of Otolaryngology, İstanbul, Turkey.
| | - Tuğçe Uzar
- University of Health Sciences, Umraniye Training and Research Hospital, Department of Otolaryngology, Istanbul, Turkey.
| | - Serap Önder
- Acibadem Ataşehir Hospital, Istanbul, Turkey.
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Hall N, Rousseau N, Hamilton DW, Simpson AJ, Powell S, Brodlie M, Powell J. Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals. BMJ Open 2023; 13:e065698. [PMID: 36720577 PMCID: PMC9890767 DOI: 10.1136/bmjopen-2022-065698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To explore the experience of caring for children with tracheostomies from the perspectives of parents and health professional caregivers. DESIGN Qualitative semistructured interview study. SETTING One region in England covered by a tertiary care centre that includes urban and remote rural areas and has a high level of deprivation. PARTICIPANTS A purposive sample of health professionals and parents who care for children who have, or have had, tracheostomies and who received care at the tertiary care centre. INTERVENTION Interviews undertaken by telephone or video link. PRIMARY AND SECONDARY OUTCOME MEASURES Qualitative reflexive thematic analysis with QSR Nvivo 12. RESULTS This paper outlines key determinants and mediators of the experiences of caregiving and the impact on psychological and physical health and quality of life of parents and their families, confidence of healthcare providers and perceived quality of care. For parents, access to care packages and respite care at home as well as communication and relationships with healthcare providers are key mediators of their experience of caregiving, whereas for health professionals, an essential influence is multidisciplinary team working and support. We also highlight a range of challenges focused on the shared care space, including: a lack of standardisation in access to different support teams, care packages and respite care, irregular training and updates, and differences in health provider expertise and experiences across departments and shift patterns, exacerbated in some settings by limited contact with children with tracheostomies. CONCLUSIONS Understanding the experiences of caregiving can help inform measures to support caregivers and improve quality standards. Our findings suggest there is a need to facilitate further standardisation of care and support available for parent caregivers and that this may be transferable to other regions. Potential solutions to be explored could include the development of a paediatric tracheostomy service specification, increasing use of paediatric tracheostomy specialist nurse roles, and addressing the emotional and psychological support needs of caregivers.
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Affiliation(s)
- Nicola Hall
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Surgical, Diagnostic and Devices Division, University of Leeds, Leeds, UK
| | - David W Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - A John Simpson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Powell
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Jason Powell
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
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Antoniou I, Wray J, Kenny M, Hewitt R, Hall A, Cooke J. Hospital training and preparedness of parents and carers in paediatric tracheostomy care: A mixed methods study. Int J Pediatr Otorhinolaryngol 2022; 154:111058. [PMID: 35139446 DOI: 10.1016/j.ijporl.2022.111058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/03/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Within the UK, the majority of paediatric tracheostomy care is delivered by parents and carers at home. To facilitate this, extensive in-hospital training is delivered by a variety of health care professionals. Our goal was to assess carer perceptions of this process and highlight areas in which we can further improve our service and the training for other hospital providers of paediatric tracheostomy care. METHODS A mixed method approach was adopted. In Phase I, qualitative data from five semi-structured interviews with carers of children with a tracheostomy were thematically analysed and subsequently used to develop a questionnaire. In Phase II, the piloted questionnaire was distributed via telephone, email or post to all eligible caregivers who had been tracheostomy trained at GOSH in the last three years (n = 92). Qualitative and quantitative data were analysed using thematic analysis and descriptive statistics respectively. RESULTS Thirty-five completed questionnaires were received (38% response rate). Overall participants were highly satisfied with the training provided (mean score 8.42 on a scale of 1 (lowest) to 10 (highest)). Carer identified areas requiring improvement were caregiver education pre-tracheostomy; emergency and complication training; supervision and training post hospital discharge; training schedule; emotional support; and support from community healthcare teams. These findings led to multiple subsequent interventions to further improve the carer training programme including training videos, psychology provision on request and increased community training. CONCLUSION Although the evaluation of the service revealed high participant satisfaction in home carer training overall, in-depth analysis of caregivers' experiences indicated common themes in the tracheostomy training service where further support would be beneficial. A carer-centred rather than health professional focus on training needs will allow future attention to be directed to areas of need identified by carers themselves as important to improve the tracheostomy training programme.
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Affiliation(s)
| | - Jo Wray
- Great Ormond Street Hospital, London, UK
| | | | | | | | - Jo Cooke
- Great Ormond Street Hospital, London, UK.
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7
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Hall N, Rousseau N, Hamilton DW, Simpson AJ, Powell S, Brodlie M, Powell J. Impact of COVID-19 on carers of children with tracheostomies. Arch Dis Child 2022; 107:e23. [PMID: 34887248 PMCID: PMC8668410 DOI: 10.1136/archdischild-2021-322979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore the impact of the COVID-19 pandemic on the experiences of caregivers of children with tracheostomies. DESIGN Qualitative semistructured interviews. SETTING All participants were currently, or had previously cared for, a tracheostomised child who had attended a tertiary care centre in the North of England. Health professionals were purposively sampled to include accounts from a range of professions from primary, community, secondary and tertiary care. PARTICIPANTS Carers of children with tracheostomies (n=34), including health professionals (n=17) and parents (n=17). INTERVENTIONS Interviews were undertaken between July 2020 and February 2021 by telephone or video link. MAIN OUTCOME MEASURE Qualitative reflexive thematic analysis with QSR NVivo V.12. RESULTS The pandemic has presented an additional and, for some, substantial challenge when caring for tracheostomised children, but this was not always felt to be the most overriding concern. Interviews demonstrated rapid adaptation, normalisation and varying degrees of stoicism and citizenship around constantly changing pandemic-related requirements, rules and regulations. This paper focuses on four key themes: 'reconceptualising safe care and safe places'; 'disrupted support and isolation'; 'relationships, trust and communication'; and 'coping with uncertainty and shifting boundaries of responsibility'. These are described within the context of the impact on the child, the emotional and physical well-being of carers and the challenges to maintaining the values of family-centred care. CONCLUSIONS As we move to the next phase of the pandemic, we need to understand the impact on vulnerable groups so that their needs can be prioritised.
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Affiliation(s)
- Nicola Hall
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Nikki Rousseau
- Surgical, Diagnostic and Devices Division, University of Leeds, Leeds, UK
| | - David W Hamilton
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - A John Simpson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Powell
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Jason Powell
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
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8
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Gulla KM, Sahoo T, Sachdev A. Technology-dependent children. Int J Pediatr Adolesc Med 2020; 7:64-69. [PMID: 32642538 PMCID: PMC7335821 DOI: 10.1016/j.ijpam.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Abstract
In recent past, revolution in medical technology resulted in improved survival rates and outcomes of critically ill children. Unfortunately, its impact relating to morbidity is not well documented. Although survival rates of these critically ill children who are medically fragile and technology-dependent have improved, we as health professionals are still in the learning curve to improve the quality of life of these children at home. Factors such as support from society, infrastructure, and funding play an important role in technology-dependent child care at home. In this review, commonly prescribed home-based medical technologies such as home ventilation, enteral nutrition, renal replacement therapy, and peripherally inserted central catheter, which are useful for quick revision, are described.
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Affiliation(s)
- Krishna Mohan Gulla
- Division of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Tanushree Sahoo
- Division of Neonatology, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Sachdev
- Division of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
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9
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Gong S, Wang X, Wang Y, Qu Y, Tang C, Yu Q, Jiang L. A Descriptive Qualitative Study of Home Care Experiences in Parents of Children with Tracheostomies. J Pediatr Nurs 2019; 45:7-12. [PMID: 30594889 DOI: 10.1016/j.pedn.2018.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The number of pediatric patients who require a long-term tracheal tube at home is gradually increasing. Studies have demonstrated that the parents of these children report high levels of stress, anxiety and other negative emotions as early as shortly after discharge from the hospital. The purpose of this study is to describe the home care experiences of parents of children with tracheostomies during the transition from hospital to home in China to more effectively address their needs. DESIGN AND METHODS This study used a qualitative descriptive design and face-to-face interviews with semi-structured questions to learn about the home care experiences of parents whose children had undergone a tracheostomy. RESULTS Thirteen parents were recruited from the otorhinolaryngology outpatient ward of Xinhua Hospital in Shanghai, China. These parents described three categories of home care experiences: "direct care overload," "psychological overload," and "personal growth." Subcategories included parental "role change," "from helplessness to skillfulness," "lack of professional support," "anxiety and depression," and "social isolation." They also reported personal growth, which was mainly reflected by "changing their perspectives" and "developing potential." CONCLUSION Although the findings of this study indicate that the physical and psychological overload reported by parents of children with tracheostomies during home care is inevitable, a better understanding of parents' caring experiences among professionals may facilitate clinical practice and promote continued community nursing care in China. PRACTICE IMPLICATIONS Parents hope to receive systematic education during hospitalization, including web-based video education for skills training after discharge. In addition, parents desire public recognition so that they can participate in normal family and community activities.
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Affiliation(s)
- Shumei Gong
- Paediatric Surgery, Xin Hua Hospital Affiliated to Shang Hai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiaoling Wang
- Oncology Ward, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqing Wang
- Otolaryngology Head & Neck Surgery, Xin Hua Hospital Affiliated to Shang Hai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinghua Qu
- Department of Nursing, Xin Hua Hospital Affiliated to Shang Hai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunyan Tang
- Paediatric Surgery, Xin Hua Hospital Affiliated to Shang Hai Jiao Tong University School of Medicine, Shanghai, China
| | - Qun Yu
- Department of Nursing, Xin Hua Hospital Affiliated to Shang Hai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Department of Nursing, Xin Hua Hospital Affiliated to Shang Hai Jiao Tong University School of Medicine, Shanghai, China
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Joseph RA, Goodfellow LM, Simko LM. Parental quality of life: caring for an infant or toddler with a tracheostomy at home. Neonatal Netw 2018; 33:86-94. [PMID: 24589900 DOI: 10.1891/0730-0832.33.2.86] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the relationships between stress, coping, duration of tracheostomy, and quality of life (QOL) of parental caregivers who care for a child with a tracheostomy at home. DESIGN A cross-sectional correlational design was used to study parents who care for a child with a tracheostomy at home. Family Inventory of Life Events, Family Crisis Oriented Personal Evaluation Scale, and Psychological General Well-Being Index were used to measure stress, coping, and QOL, respectively. Data were collected using both online and paper-pencil format. MAIN OUTCOME VARIABLE quality of life. RESULTS Parents who care for their infants/toddlers with a tracheostomy at home were found to be in moderate distress. Mean age of the participants was 33 years (N = 71), and the average duration of the child's tracheotomy was 18.22 (SD = 9.59) months. Multivariate analysis showed a significant inverse relationship between QOL and stress. QOL was significantly associated with coping, B = 19.91, β = .43, p <.001.
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11
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Amin R, Zabih W, Syed F, Polyviou J, Tran T, Propst EJ, Holler T. What families have in the emergency tracheostomy kits: Identifying gaps to improve patient safety. Pediatr Pulmonol 2017; 52:1605-1609. [PMID: 28556570 DOI: 10.1002/ppul.23740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the contents of parent-created emergency tracheostomy kits and identify deficiencies. METHODS This was an observational study. Data on emergency tracheostomy kits were abstracted for 30 consecutive children who had a tracheostomy tube in situ during an outpatient clinic visit with the Division of Respiratory Medicine and/or the Department of Otolaryngology-Head and Neck Surgery at the Hospital for Sick Children between February 1 and October 30, 2016. A checklist of 12 essential items based on expert consensus was used to evaluate each tracheostomy kit. RESULTS Emergency tracheostomy kits from all children were missing at least one item from the 12-item checklist. Nineteen (63%) kits had three or more critical items missing. All kits had the same size tracheotomy tube. Twenty-two (73%) kits did not have a half size smaller tracheostomy tube. Fifteen (50%) were missing a manual resuscitation bag and four (13.3%) were missing a suction machine. Children who had tracheostomy tube in situ for ≥4 years were more likely to have ≥3 missing items in their kit (43.4%) compared to those who had tracheostomy tube for <4 years (20%), (χ2 (1) = 9.85, P = 0.0017). CONCLUSION Maintenance of a fully stocked emergency tracheostomy kit can save a child's life. It is incumbent upon healthcare providers to ensure ongoing reassessment of knowledge and skills required to care for a child with a tracheostomy tube and to regularly review the components of a child's emergency tracheostomy kit.
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Affiliation(s)
- Reshma Amin
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Weeda Zabih
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Faiza Syed
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Polyviou
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tuyen Tran
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Evan J Propst
- University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Theresa Holler
- University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Chiang J, Amin R. Respiratory Care Considerations for Children with Medical Complexity. CHILDREN-BASEL 2017; 4:children4050041. [PMID: 28534851 PMCID: PMC5447999 DOI: 10.3390/children4050041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/08/2017] [Accepted: 05/16/2017] [Indexed: 12/13/2022]
Abstract
Children with medical complexity (CMC) are a growing population of diagnostically heterogeneous children characterized by chronic conditions affecting multiple organ systems, the use of medical technology at home as well as intensive healthcare service utilization. Many of these children will experience either a respiratory-related complication and/or they will become established on respiratory technology at home during their care trajectory. Therefore, healthcare providers need to be familiar with the respiratory related complications commonly experienced by CMC as well as the indications, technical and safety considerations and potential complications that may arise when caring for CMC using respiratory technology at home. This review will outline the most common respiratory disease manifestations experienced by CMC, and discuss various respiratory-related treatment options that can be considered, including tracheostomy, invasive and non-invasive ventilation, as well as airway clearance techniques. The caregiver requirements associated with caring for CMC using respiratory technology at home will also be reviewed.
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Affiliation(s)
- Jackie Chiang
- Holland Bloorview Kids Rehabilitation Hospital, The University of Toronto, Toronto, ON M4G 1R8, Canada.
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, The University of Toronto, Toronto, ON M5G 1X8, Canada.
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McDonald J, McKinlay E, Keeling S, Levack W. The ‘wayfinding’ experience of family carers who learn to manage technical health procedures at home: a grounded theory study. Scand J Caring Sci 2017; 31:850-858. [DOI: 10.1111/scs.12406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Janet McDonald
- Department of Primary Health Care and General Practice; University of Otago; Wellington New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice; University of Otago; Wellington New Zealand
| | - Sally Keeling
- Department of Medicine; University of Otago; Christchurch New Zealand
| | - William Levack
- Rehabilitation Teaching and Research Unit; Department of Medicine; University of Otago; Wellington New Zealand
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Callans KM, Bleiler C, Flanagan J, Carroll DL. The Transitional Experience of Family Caring for Their Child With a Tracheostomy. J Pediatr Nurs 2016; 31:397-403. [PMID: 27040188 DOI: 10.1016/j.pedn.2016.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/07/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED The purpose of this qualitative study was to describe the family experience of caring for their child with a tracheostomy due to a compromised airway during the transition from hospital to home, and to identify types of support that families request to be successful caregivers. DESIGN AND METHODS This study used a qualitative descriptive design with focus groups to answer semi-structured interview questions. The investigators followed basic content analysis to interpret descriptive data using three-person consensus. RESULTS Eighteen family members participated. Four themes emerged: "This is not the life I had planned: coming to accept the new reality;" "Don't make the hospital your home; don't make your home a hospital;" "Caregivers engage with providers that demonstrate competence, confidence, attentiveness, and patience;" and "Participants value the opportunity to give back and help others." CONCLUSIONS Growth in the family caregiver role leads to personal transformation demonstrated by increased confidence, finding joy from their child, becoming an advocate for their child, and a resource for others. Family members described the transition to being 'in charge,' the relationship with the provider, and being able to advocate for getting the resources they needed in the home. PRACTICE IMPLICATIONS Relationships are as critical as teaching skills to families during hospitalization. Family members see considerable value in connecting with care providers. In addition, there is a desire to share their experience with other families that are beginning a similar journey. Participants requested a support approach that included competent providers, Web-based video education for skills training, family-to-family connection, and continued family group support after discharge.
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Affiliation(s)
- Kevin Mary Callans
- Clinical Care Management Unit, Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary, Boston, MA.
| | - Carolyn Bleiler
- Patient Care Services, Massachusetts General Hospital, Boston MA
| | - Jane Flanagan
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston MA and Boston College, Chestnut Hill MA
| | - Diane L Carroll
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston MA
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Cottrill E, Lioy J, Elshenawy S, Rosenzweig J, Hopkins E, Chuo J, Sobol S, DeMauro S. A five year retrospective study of short term respiratory support outcomes for infants who received tracheostomy before one year of age. Int J Pediatr Otorhinolaryngol 2015; 79:15-7. [PMID: 25481332 DOI: 10.1016/j.ijporl.2014.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/28/2014] [Accepted: 10/04/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to describe respiratory support requirements at the time of hospital discharge for infants who undergo tracheostomy, and to determine whether certain indications for tracheostomy are significantly associated with ventilator or oxygen dependence at the time of discharge. METHODS Retrospective chart review identified 150 patients who underwent tracheostomy before 1 year of age at a single center from 2007 to 2012 and were discharged alive. Patients were divided into groups based on primary indication for tracheostomy: chronic lung disease (CLD); cardiac; airway anomalies (e.g., tracheomalacia, subglottic stenosis); anatomic anomalies of head, neck and chest; neuro/muscular; mixed group (>1 primary indication). Chi-squared tests were used to compare respiratory support requirements at time of discharge, as well as need for supplemental oxygen. RESULTS Of the 150 patients included in the study, three were discharged on room air alone. Of those 147 who did require some form of support at discharge, significant differences were found between groups when comparing CPAP to ventilator support. For example, of the patients with CLD, 82% were discharged on ventilator support whereas of those with a primary airway indication nearly 54% were discharged on CPAP. Significant differences were also found among groups when comparing patients discharged on room air vs. supplemental oxygen. Patients with CLD were more likely to be discharged on supplemental oxygen (p=0.001) whereas of the patients with anatomic indication 77% required no supplemental oxygen at the time of discharge. CONCLUSION Respiratory support needs at the time of discharge for neonates who underwent tracheostomy varied significantly depending on the initial indication for tracheostomy. Information about respiratory requirements of infants who undergo tracheostomy can help clinicians counsel families and anticipate post-discharge needs.
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Affiliation(s)
- Elizabeth Cottrill
- Otorhinolaryngology, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Janet Lioy
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Summer Elshenawy
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jaclyn Rosenzweig
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Edward Hopkins
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - John Chuo
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Steven Sobol
- Otorhinolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sara DeMauro
- Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Parida PK, Kalaiarasi R, Gopalakrishnan S, Saxena SK. Fractured and migrated tracheostomy tube in the tracheobronchial tree. Int J Pediatr Otorhinolaryngol 2014; 78:1472-5. [PMID: 24984926 DOI: 10.1016/j.ijporl.2014.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study the clinical presentation and management of fractured tracheostomy tube (FTT) presenting as tracheobronchial foreign body (FB) in children. METHODS A retrospective chart review of children with a diagnosis of FTT, FB in tracheobronchial tree was carried out. Data regarding the patients' demographic details, diagnosis, clinical presentation and management were noted and analyzed. RESULTS Total 8 cases (males 3 and females 5, average age 8.8 years, range 1-15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months-4 years) were found. Indications for tracheostomy were bilateral abductor palsy, subglottic stenosis and congenital subglottic hemangioma in 4 (50%), 3 (37.5%) and 1 (12.5%) cases, respectively. Classical triad of FB aspiration (coughing/choking, wheezing and reduced breath sounds) was present in 6 (75%) patients. Aspirated FTTs were Jackson's metallic inner tube, Romson's polyvinyl chloride plastic tube and Fuller's outer tube flange in 4 (50%), 3 (37.5%) and 1 (12.5%) respectively. The most common fracture site was at the junction between tube and neck plates {in 7 (87.5%) children}. Sites of lodgment of FTT were right bronchus, trachea and both trachea and left bronchus in 5 (62.5%), 2 (25%) and 1 (12.5%) cases, respectively. FTTs were retrieved by transtracheostomal rigid bronchoscopy and exploring the tracheostomal wound in 7 cases and 1 case, respectively. CONCLUSION Though FTT presenting as pediatric tracheobronchial FB is rare, it should be considered in differential diagnosis in a tracheostomised child with respiratory distress. When diagnosed, FTT removal is best done using a rigid bronchoscope through the tracheal stoma.
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Affiliation(s)
- Pradipta Kumar Parida
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - Raja Kalaiarasi
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Sunil Kumar Saxena
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Abstract
Shared decision-making is a process that helps frame conversations about value-sensitive decisions, such as introduction of assistive technology for children with neurologic impairment. In the shared decision-making model, the health care provider elicits family values relevant to the decision, provides applicable evidence in the context of those values, and collaborates with the family to identify the preferred option. This article outlines clinical, quality of life, and ethical considerations for shared decision-making discussions with families of children with neurologic impairment about gastrostomy tube and tracheostomy tube placement.
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Double ABCX model of stress and adaptation in the context of families that care for children with a tracheostomy at home: application of a theory. Adv Neonatal Care 2014; 14:172-80. [PMID: 24777041 DOI: 10.1097/anc.0000000000000062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Theories provide a roadmap for scientific inquiry, help organize knowledge, and establish the foundation for knowledge development. The Double ABCX Model of Family Stress and Adaptation is a middle-range theory developed in social science and widely used by researchers of various disciplines. This model encompasses the major variables of interest in this study, including stress, coping, duration of tracheostomy, and quality-of-life, and forms an excellent framework for this specific research study. The purpose of this article was to discuss relationships between various individual and environmental factors that can impact health and well-being in families. In addition, this article illustrates how the application of the model helps nurses and healthcare providers understand the significance of the family context on positive well-being and promote optimal caring practices to achieve a balance in the midst of illness and suffering.
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Flynn AP, Carter B, Bray L, Donne AJ. Parents' experiences and views of caring for a child with a tracheostomy: a literature review. Int J Pediatr Otorhinolaryngol 2013; 77:1630-4. [PMID: 23953483 DOI: 10.1016/j.ijporl.2013.07.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/16/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To review the published/reported experiences and views of parents' whose child has had a tracheostomy. To date, no review has focused specifically on parents' experiences and views of having a child with a tracheostomy. METHODS MEDLINE, CINAHL, PsycINFO and Embase were systematically searched from 1990 to 2012 and a review of reference lists was conducted. The review draws on articles where parents' views of caring for their child's tracheostomy were either the sole focus of the research or where parental views of caring for their child's tracheostomy have been sought as a subsidiary aim. Studies relating to the aims of the review were examined using quality appraisal tools and in line with criteria for inclusion of studies. Studies were excluded if findings were about adults, studies that only focused on children's or sibling's views were not based on empirical work (e.g. literature reviews or expert commentary) or were not published in the English language. Findings were summarised under thematic headings. RESULTS The systematic database search identified 442 citations of which 10 were eligible for inclusion in the review. Of those 10 studies six were quantitative and four qualitative. Only one paper published qualitative data specifically on parents' experiences about their tracheotomised child. The three main themes identified were parents' experiences of caregiving, their social experiences and experiences of service delivery of having a child with a tracheostomy. Although parents encountered emotional and social challenges, some positive responses to these challenges were reported. CONCLUSION This review identifies a lack of qualitative research on parents' views of having a child with a tracheostomy. Issues surrounding parental management of tracheostomy require further investigation. This review has identified the need to elicit parents' longitudinal experiences of having a child with a tracheostomy.
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Affiliation(s)
- A P Flynn
- Department of ENT, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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McClean EB. Tracheal suctioning in children with chronic tracheostomies: a pilot study applying suction both while inserting and removing the catheter. J Pediatr Nurs 2012; 27:50-4. [PMID: 22222106 DOI: 10.1016/j.pedn.2010.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 11/24/2010] [Accepted: 11/25/2010] [Indexed: 10/18/2022]
Abstract
This pilot study compared two methods of tracheal suctioning in the same 18 children with chronic tracheostomies. Use of the American Thoracic Society (ATS) recommendations resulted in a significant increase in secretions obtained (t = -3.96; p = .001) when compared with traditional practice. The ATS-recommended method was also more efficient in children with secretions. When used first, no additional secretions were obtained after 90 minutes using the traditional method. Additional secretions were obtained with the ATS-recommended method when the traditional method was used first. Heart rate and oxygen saturation immediately and 1 minute after suctioning were not significantly different between methods.
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21
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Abstract
Children with tracheostomies are increasingly discharged home for continued care by their parents. Nurses are responsible for providing these parents with the extensive education required for a smooth and successful transition to home care. This article is intended to help neonatal and pediatric nurses to effectively prepare the parents of an infant with a tracheostomy to provide safe, quality care to their child after being discharged from an acute care setting to their home. This article discusses the knowledge, attitudes, and skills the parents are required to acquire prior to the infant's discharge. Home ventilation, airway management, suctioning, tracheostomy care, emergency management, safe home environment, equipment for continuous or intermittent ventilation, and supplies necessary for care are some of the topics discussed.
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Sousa A, Nunes T, Roque Farinha R, Bandeira T. Traqueostomia: Indicações e complicações em doentes pediátricos. REVISTA PORTUGUESA DE PNEUMOLOGIA 2009. [DOI: 10.1016/s0873-2159(15)30129-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Graf JM, Montagnino BA, Hueckel R, McPherson ML. Children with new tracheostomies: planning for family education and common impediments to discharge. Pediatr Pulmonol 2008; 43:788-94. [PMID: 18613098 DOI: 10.1002/ppul.20867] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To describe an educational program and timeline for the discharge of children with a new tracheostomy and identify common impediments to the education and discharge process. METHODS Retrospective pilot case series of 70 children and adolescents undergoing tracheostomy placement over a 24-month period in a large urban academic pediatric hospital. RESULTS Eleven healthcare providers with expertise with technology dependent children identified the eight most common impediments to education and discharge for children with new tracheostomies. Length of stay, impediments to both education and discharge, and medical equipment needed at the time of discharge were extracted from hospital records. Caregivers of children with new tracheostomies needed a median of 14 days (range 5-110 days) to successfully complete a tracheostomy education program. Discharge occurred a median of 6.5 days (range 0-71 days) after education was completed. Common impediments to completing the education program included social issues (e.g., lack of sibling childcare), inter-current illness of the patient and/or language barriers. Impediments to discharge included patient's inter-current illnesses, social issues (e.g., lack of running water) and unavailability of home nursing. Our cohort of patients had a total median length of stay (LOS) of 46 days. At discharge, 55% of children required two or more medical devices (in addition to their tracheostomy) and 61% had some level of dependency on positive pressure ventilation. CONCLUSIONS Pediatric patients with a new tracheostomy undergo lengthy initial hospitalizations and have complex educational and discharge needs. Multiple factors (both medical and social) can impede the child's transition to the outpatient setting. A structured education and discharge program may result in a shorter LOS for children with new tracheostomies. Impediments to family education and discharge should be anticipated.
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Affiliation(s)
- Jeanine M Graf
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
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Paul F, Jones MC, Hendry C, Adair PM. The quality of written information for parents regarding the management of a febrile convulsion: a randomized controlled trial. J Clin Nurs 2007; 16:2308-22. [DOI: 10.1111/j.1365-2702.2007.02019.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
There are hardly any controlled studies in paediatric tracheostomy care; instead, most established standards, procedures and details have been elaborated at the bedside by trial and error. Once the appropriate tube is chosen, tube care consists of tube change, fixation, management of secretions, humidification of inspired air and application of medications. The stoma requires cleaning, protection and dressing. Child care may be structured into monitoring, feeding, bathing and clothing. Preparing the home and family environment are important prerequisites for discharge from the hospital. Last but not least, the family of the child or other caregivers must undergo a structured and detailed training programme to become competent in long-term home care.
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Affiliation(s)
- Béatrice Oberwaldner
- Respiratory and Allergic Disease Division, Paediatric Department, Medical University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria.
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Toussaint M, Steens M, Van Zeebroeck A, Soudon P. Is disinfection of mechanical ventilation tubing needed at home? Int J Hyg Environ Health 2005; 209:183-90. [PMID: 16376145 DOI: 10.1016/j.ijheh.2005.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 09/09/2005] [Accepted: 09/20/2005] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Home mechanical ventilation is used to treat chronic alveolar hypoventilation. Maintenance protocols for home ventilation circuits (HVC) remain empirical and unproven. We have investigated (1) the cleanliness and sterility of the HVC used by home ventilated patients and (2) the efficiency of tubing cleaning and decontamination protocols recommended to them and used for 12 months or more. METHOD HVC cleanliness was assessed in 39 severe restrictive ventilated patients (16 (T) tracheostomy vs. 23 (N) noninvasive) and in 7 new valves as control. In the first experiment (Exp1), a visual and bacteriologic inspection of the expiratory valve (Eva) was conducted during a consultation in our centre. Eva visual cleanliness was assessed on a 10-point scale and Eva bacteriologic contamination analysis was performed on a dry smear. In the second experiment (Exp2), these analyses were repeated after a cleaning sequence chosen at random, either chemical (ammonium-chlorhexidine complex) (A) or mechanical by dishwasher (B). RESULTS In Exp1, 69% of Eva were dirty. Dirtiness was worse in (T) than in (N) (5.3 vs. 2; p<0.001). There was a significant positive correlation between visual cleanliness and bacteriologic contamination (r=0.56; p<0.001). Eva in group (T) were more contaminated than in group (N) (p<0.001). Eva contamination rates reached 22% in group (N) but without the presence of any potentially pathogenic organisms (PPO) and 81% in group (T) where 19% were PPO. In Exp2, EVA visual cleanliness was better after dishwasher cleaning (B) compared to chemical (A) (0.16 vs. 1.05; p<0.001) with similar bacteriological decontamination. CONCLUSION HVC from noninvasive ventilated patients are dirty but not contaminated by PPO. We recommend washing them in a dishwasher or with detergent and hot water without specific disinfection. PPO contaminated 1/5 of invasive HVC, for which we recommend dishwasher cleaning. Decontamination is only indicated when tubing is visually very dirty or/and when tracheostomized patients are particularly sensitive to respiratory tract infections. The expiratory valve must be carefully washed specifically, with care that its balloon is not placed under water.
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Affiliation(s)
- Michel Toussaint
- Centre for Home Mechanical Ventilation Z.H. Inkendaal and Excellence Centre for Neuromuscular Disorders, Inkendaalstraat 1, 1602 Vlezenbeek, Brussels, Belgium.
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Abstract
Increasingly, infants are discharged from the neonatal intensive care unit (NICU) with unresolved healthcare issues and ongoing technology needs. A well-planned discharge of a medically stable infant is important to assure safe and effective care in the home and to minimize avoidable hospital readmissions. This article addresses the discharge of and home care options for 3 groups of infants who have traditionally been cared for in the hospital. These include infants requiring palliative care, infants who are technology dependent, and those stable premature infants requiring intensive home support. Intermittent and continuous home nursing care options are defined, and the goals of home care nursing are outlined. The importance of objective discharge criteria and medical stability is discussed along with practical tips and strategies to assure success. A teaching tool to assist parents in choosing a home care provider is included.
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Affiliation(s)
- Pat Hummel
- Loyola University Medical Center, Maywood, IL 60153, USA.
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