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Changing times
• Changing indications for tracheostomy
• Fewer short-term tracheostomies
• Most for chronic problems leading to tracheostomy use for months or years
Parental competency in tracheostomy management
• 2 carers trained• Gain competencies in:– Suctioning tube– Changing tapes– Changing tubes– Coping with emergencies• Tube obstruction• Tube dislodgement
– Basic paediatric life support
Study Objectives
• To review indications and length of hospital stay in children undergoing tracheostomy
• To highlight reasons for prolonged hospitalisation once medically fit
• Identify impediments to timely discharge
Methods
• 10 year retrospective study 2000 – 2010
• All children undergoing tracheostomy in LTH– Mr Knight, Mr Crabbe
• Identified using theatre database
• Case notes reviewed
Data collected
• Demographics• Indication for tracheostomy• Length of hospital stay• Reasons for extended stay • Destination on discharge• Mortality
Results
• 109 children identified
• 101 notes reviewed – Age range 0-15 years
• ENT - Mr Knight – 47
• Paed Surgery - Mr Crabbe – 45
• Other - 9
Indications
To facilitate artificial ventilation
• Weaning from ventilator• Needs prolonged ventilation• Needs regular pulmonary
toilet
To relieve upper airway obstruction
• Bypass blockage or narrowing in upper airway
Indications for tracheostomySubglottic stenosis (congenital = 4) 34
Wean from ventilator (infection / tracheomalacia) 15
Wean from ventilator (head injury) 14
Ventilator dependant (myopathy / hypoventilation) 11
Micrognathia / Macroglossia 10
Lymphangioma / Cyst 5
Haemangioma 4
Bilateral vocal cord palsy 4
Oral tumour 2
Vocal cord granuloma 1
Nasopharyngeal stenosis 1
Indications for tracheostomySubglottic stenosis (congenital = 4) 34
Wean from ventilator (infection / tracheomalacia) 15
Wean from ventilator (head injury) 14
Ventilator dependant (myopathy / hypoventilation) 11
Micrognathia / Macroglossia 10
Lymphangioma / Cyst 5
Haemangioma 4
Bilateral vocal cord palsy 4
Oral tumour 2
Vocal cord granuloma 1
Nasopharyngeal stenosis 1
Indications for tracheostomySubglottic stenosis (congenital = 4) 34
Wean from ventilator (infection / tracheomalacia) 15
Wean from ventilator (head injury) 14
Ventilator dependant (myopathy / hypoventilation) 11
Micrognathia / Macroglossia 10
Lymphangioma / Cyst 5
Haemangioma 4
Bilateral vocal cord palsy 4
Oral tumour 2
Vocal cord granuloma 1
Nasopharyngeal stenosis 1
Indications for tracheostomySubglottic stenosis (congenital = 4) 34
Wean from ventilator (infection / tracheomalacia) 15
Wean from ventilator (head injury) 14
Ventilator dependant (myopathy / hypoventilation) 11
Micrognathia / Macroglossia 10
Lymphangioma / Cyst 5
Haemangioma 4
Bilateral vocal cord palsy 4
Oral tumour 2
Vocal cord granuloma 1
Nasopharyngeal stenosis 1
Indications for tracheostomySubglottic stenosis (congenital = 4) 34
Wean from ventilator (infection / tracheomalacia) 15
Wean from ventilator (head injury) 14
Ventilator dependant (myopathy / hypoventilation) 11
Micrognathia / Macroglossia 10
Lymphangioma / Cyst 5
Haemangioma 4
Bilateral vocal cord palsy 4
Oral tumour 2
Vocal cord granuloma 1
Nasopharyngeal stenosis 1
Indications for tracheostomySubglottic stenosis (congenital = 4) 34
Wean from ventilator (infection / tracheomalacia) 15
Wean from ventilator (head injury) 14
Ventilator dependant (myopathy / hypoventilation) 11
Micrognathia / Macroglossia 10
Lymphangioma / Cyst 5
Haemangioma 4
Bilateral vocal cord palsy 4
Oral tumour 2
Vocal cord granuloma 1
Nasopharyngeal stenosis 1
Indications for tracheostomySubglottic stenosis (congenital = 4) 34
Wean from ventilator (infection / tracheomalacia) 15
Wean from ventilator (head injury) 14
Ventilator dependant (myopathy / hypoventilation) 11
Micrognathia / Macroglossia 10
Lymphangioma / Cyst 5
Haemangioma 4
Bilateral vocal cord palsy 4
Oral tumour 2
Vocal cord granuloma 1
Nasopharyngeal stenosis 1
More than 12 weeks
• 5 children
• Multiple factors– awaiting changes to housing – 3 – social problems – 3 – tracheostomy training – 1
Delays due to….
• Equipment provision• Changes to home environment• Parental tracheostomy training – 22 children
• Social factors
Social & external factors
• Concerns about parenting ability
• Parental drug and alcohol abuse
• Family on “at risk register”
• Children placed in foster care– 5 children
What can we do?
• Can’t prevent external factors
• Early enrolment of parents on structured training programme
• Early involvement of social care organisations• Good integration of medical, social and
outreach services
What can we do?
• Dedicated paediatric tracheostomy nurse specialist to coordinate the discharge of infants and children with tracheostomies