Regular tracheostomy tube changes to prevent formation of granulation tissue.
OBJECTIVE
Tracheostomy is a commonly performed operative procedure that has been described since 2000 B.C. The early indications for tracheostomy were for upper airway obstruction, usually occurring in young people as a result of an infectious process. Recently, tracheostomies are more commonly performed in the critically ill patient to assist in long-term ventilatory support. Granulation tissue at the stoma and the trachea has been described as a late complication resulting in bleeding, drainage, and difficulty with maintaining mechanical ventilatory support.


METHODS
The present report is of an observational study of a newly implemented policy that required regular changing of tracheostomy tubes. Comparable groups of patients were compared before and after this procedural change to document complications. Data collection consisted of chart reviews of all admissions for 1 year before the policy change and the subsequent 2 years. Complication rates were compared using standard statistical techniques.


METHODS
A policy change was instituted that required all tracheostomy tubes to be changed every 2 weeks in conjunction with a detailed evaluation of the tracheostomy stoma. Charts were reviewed the year before the change in policy and in the subsequent 2 years to determine the incidence of granulation tissue requiring operative intervention.


RESULTS
The number of patients requiring surgical intervention secondary to granulation tissue showed a statistically significant decrease (P =.02). A review of policies and procedures from the six largest hospitals in southeastern Michigan had no recommendations for routine tracheostomy tube changes.


CONCLUSIONS
A policy requiring a routine change of tracheostomy tubes results in fewer complications from granulation tissue. Tracheostomy tube changes to prevent granulation tissue and its complications.
Yaremchuk
Kathleen
K
Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. kyaremc1@hfhs.org
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001707:Biopsy, Needle; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D020878:Device Removal / Q000592:standards*; D004106:Dilatation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006097:Granulation Tissue / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011050:Policy Making; D011322:Primary Prevention / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D054047:Surgical Stomas / Q000473:pathology*; D014135:Tracheal Stenosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D014139:Tracheostomy / Q000009:adverse effects* / Q000295:instrumentation*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents