I am looking for any information on when to do routine tracheostomy tube changes. there is very little evidence in the literature, i have found an article in The Larygoscope vol 113(1) p 1-10, recommending changing a trach every two weeks to prevent grannulation formation, cost analysis was about $30000 pre patient per year. another article in Chest as a poster presentation recommended every six weeks but there was little information; Chest 2003 (meeting abstracts)Oct 1 p 203.
maybe as a group we could come up with a consensus.
We are a pediatric facility and change trachs weekly. Our patients need changes weekly as the tube would clog up. A comparison would be larger children and we still change them weekly. I have not seen any justification through the literature. Most patients have enough secretions to justify a weekly trach change no matter the size.
Two hospitals I have worked at did our trach changes Q monthly. I don't know the research behind this however. If you are worried about granulomas, as some pts. are prediposed to get these, I would reccomend to change every two weeks. If you find trach tubes are clogging with secretions, humidification and daily inner cannula changes should help with that.
I am curious to know how often people are being ordered to change trachs as well. Does anyone have an official protocol. We are pretty ad hoc here. Signs of break down, infection, granuloma. Timing varies from once a month to once a year if you can believe it.
I understand the frequency issue with Paediatric trachs which are small and often have no inner canula but with adult trachs most now use inner canulas. Is that sufficient though to change once a year if the inner canulas are changed and the trach site is clensed well?
Any new thoughts?
Have been part of a Trach Team for 4 years in Adult Trauma Centre; unless mechanically necessary, typically will change ~Qmonth.
Article in Resp Care this August shed some light I believe; author was Alexander White from Mass, USA.
The most consistent standard I have seen for changing trachs in adults is qmonth. I have not worked with trached peds much so can't really speak to that. I do not recall much problem with granulation tissue except with it entering fenestrations and and causing occlusion. I prefer single cannula trachs for weaning and speaking/capping trials as they usually have a better I.D to O.D. relationship.
We change our neonatal trachs every 7 days, except for foam cuff trach tubes, which are changed every 14 days...
Luis Mosos, RRT-NPS
St. Mary's Medical Center
West Palm Beach, FL