Frequency of Routine Tracheostomy Tube Changes: A Single-Center Retrospective Review

Abstract

Background:

Routine change of single lumen tracheostomy tubes (TT) is a vital part of airway management for patients with a tracheostomy. However, there is limited evidence to recommend frequency of routine TT change. We hypothesized clinical outcomes and adverse events would remain the same after increasing length between TT change from 7 to 14 days.

Methods:

With IRB approval, a single-center retrospective chart review was conducted from August 2021 to March 2023 on patients whose frequency of TT change decreased from 7 to 14 days. Data was collected by 4 respiratory therapists (RTs) and validated by 2 additional RTs using standardized operational definitions to ensure alignment of data extraction. Descriptive statistics were performed, and inter-rater reliability (IRR) was assessed.

Results:

Forty-three patients (41.9% male, 58.1% female) had routine TT change frequency decreased from 7 to 14 days. Median age was 21 mos (IQR:10-101), median weight 13.4 kg (IQR:10.3-25.2), 96.7% of TT were Bivona, and 91.8% were cuffed. Adverse events were characterized as skin breakdown (9%), granulation tissue (7%), tracheitis (0%), pneumonia (0%), cellulitis (0%), tracheostomy site bleeding (0%), and emergency TT change (4%). Unplanned decannulations occurred at an incidence of 18.6%. Hospital mortality occurred in 4 patients unrelated to change in frequency of TT changes. Five patients returned to weekly TT changes due to acute increase in respiratory support (2%), family/caregiver training (9%), mucous plugging (2%) and increased work of breathing (2%). IRR was assessed using percent agreement of 3 factors: 1) Did the patient’s respiratory support increase after TT change frequency was changed? 2) Did the patient need to go back to more frequent TT changes? 3) Were adverse events documented between time of change to every 14 days and discharge? 100%, 88.9%, and 66.7% agreement amongst raters was achieved, respectively. Limitation in compilation of adverse events was discovered as there is no standardized documentation at our institution. Capture of adverse events would be more accurate in a prospective trial.

Conclusions:

Decreasing the frequency of routinely changing single lumen TT from 7 to 14 days in pediatrics can be considered relatively safe. The monitoring of adverse events related to this change such as increase secretion tenacity, plugging events, or infection should be monitored and consider returning to weekly changes if they occur. Given the scarcity of literature on this topic, further research is recommended.