preventing tracheotomy related skin …...skin breakdown than the thin hydrocolloid. limitations of...

DATA CONCLUSIONSThe results support the use of split gauze under tracheotomies as more effective in preventing skin breakdown than the thin hydrocolloid. Limitations of the quality study were: physician preference, original tracheotomy ties not being changed within 7 daysand tracking length of patient stay in relation to breakdown.

Under current practice, thin hydrocolloid is placed under a

tracheotomy. The hypothesis was that split gauze worked better

at preventing breakdown than the thin hydrocolloid. The goal

was to collect data to measure the incidence of breakdown

depending on which type of intervention was utilized.

PURPOSE

A QI Project To Improve Patient Outcomes:

PREVENTING TRACHEOTOMY RELATED SKIN BREAKDOWNKatelin Palombaro, BSN, RN Susan Wasienko, BSN, RN Pamela Cavanaugh, RN Patricia Torrey, BSN, RN Mary Ellen Novak, AD, RN Judy DiPerri, MSN, RN, BC, CWOCN

BACKGROUND

Within a one year period there was an increased

incidence of tracheotomy related skin breakdown

while using only thin hydrocolloid under tracheotomies

in an ICU step down unit. The ENT service stated a

preference for use of thin hydrocolloid only to decrease

manipulation of the tracheotomy. A literature search

revealed little existing research comparing the

effectiveness of gauze versus thin hydrocolloid.

The goal of this project was to prevent tracheotomy

skin breakdown by improving current practice.

METHODSA quantitative descriptive randomized study involving a total of 45 patients comparing the use of thin hydrocolloid versus splitgauze under tracheotomies. If the patient’s tracheotomy wasplaced by ENT, nurses used thin hydrocolloid underneath and ifgeneral surgery placed the tracheotomy then the nurse used thesplit gauze underneath. The following information was collected

RESULTSOut of the 45 patients that were evaluated during the study, thinhydrocolloid was used on 24 patients and split gauze on 21 patients.From this study, results noted that the incidence of breakdown wasmuch higher when using Thin Hydrocolloid dressing (32%) thanusing Gauze (10%). Further analysis looked at nutritional status bylooking at the patient’s prealbumin level. Investigators went backand recorded each patient’s prealbumin level closest to admission

for all patients with tracheotomies: patient name, date thetracheotomy was placed and who placed it. Signs were placedat the bedside denoting which dressing to use for individualpatient. Tracheotomy skin checks were implemented weeklyand any tracheotomy breakdown that occurred was noted. All data was stored in a secure locked office.

and if they acquired breakdown then the prealbumin levelclosest to their date of breakdown. There was no significantdifference in prealbumin levels with those that developedtracheotomy related skin breakdown compared to those who did not develop breakdown.

DATA COLLECTION FORM

Edgtton-Winn, M. and Wright, K.(2005) Tracheostomy: A guide to nursing care. Australian NursingJournal; 13(5), 17

St. John, R. & Felman Malen, J. (2004) Contemporary issues in adult tracheostomy management. Crit Care Nurs Clin N Am, 16, 413-430

Dennis-Rouse, M & Davidson, J. (2008) An evidence-based evaluationof tracheostomy care practices. Critical Care Nurse Quarterly31(2), 150-160

REFERENCES

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1/11/11

1/30/11

3/5/11

1/24/11

4/21/11

4/24/11

4/17/11

8/22

9/7

POA

POA

11/25

9/16

6/23

7/14

10/20

9/2

POA

12/29

1/13

2/7

POA

2/9

4/30

5/2

5/5

09/12

12/15

10/9

10/11

2/7

5/5

8/22

8/25

8/24

11/15

11/22

9/6

6/14

7/14

9/28

9/4

1/13

12/29

1/12

2/1

3/8

3/6

4/22

4/26

4/19

3.9

15.7

12.3

17.6

5.9

25.7

9.2

14

33

9.9

14.3

35.1

18

14.2

14

13.6

9.5

13.8

5.3

9/12

12/9

9/13

10/9

2/19

5/5

13.6

16.1

15.8

10.5

9.4

21.8

PM Tube Feed; AM Pureed Diet

Mech Chop

Continuous Tube Feed







Bolus feeds




Pureed/Thickend



AdmitDate

Datetrach was

placed

Break-downDate

Prealbumin (18-38)

Close to admission

Close to breakdown

Date Level Date Level

Nutrition

Patients With Thin Hydrocolloid Dressing

7/21/11

9/22/11

12/25/11

11/26/10

12/21/10

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9/24/11

5/21/11

6/9/11

2/25/11

6/13/11

8/2/11

3/13/11

8/24

POA

POA

12/16

POA

2/3

3/3

5/19

8/11

POA

POA

POA

POA

3/21

POA

POA

POA

4/4

POA

POA

POA

6/27

4/7

7/12

POA

POA

POA

none

7/14

8/16

9/23

12/7

12/24

1/21

3/1

5/17

8/2

4/7

9/25

12/7

1/29

4/13

5/17

4/13

5/3

5/25

9/27

6/14

3/21

6/14

8/10

4/2

16.2

8.7

None

10.8

10.5

19.9

8

12

4.9

21.9

None

30.4

33.6

9.6

8.0

13.1

11.6

9.3

7.4

7.6

None

10.3

9.3

22.5

5.3

10.1

9/1

7/13

18.5

11.9










Nighttime Tube Feed

Nighttime Tube Feed

Nighttime Tube Feed

Nighttime Tube Feed

Tpn






Renal Diet



Nighttime Tube Feed, Renal

Tpn/cont tf


House/Nighttime Tube Feed

AdmitDate

Datetrach was

placed

Break-downDate

Prealbumin (18-38)

Close to admission

Close to breakdown

Date Level Date Level

Nutrition

Patients With Gauze

Unsure(10/24)

Total Patients Total Patients

Date

PCU Tracheostomy Rounds

PatientSticker Type/Size Dressing Secretions Breakdown Wound Care

Notified

Dressing Type: 1=gauze 2=duodots 3=nothing 4=marathon

Thin Hydrocolloid Gauze

preventing tracheotomy related skin …...skin breakdown than the thin hydrocolloid. limitations of...

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