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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
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8/3/10
12/30/10
12/22/10
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
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Bolus feeds
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Pureed/Thickend
Continuous Tube Feed
Continuous Tube Feed
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
1/19/11
2/22/11
5/16/11
7/27/11
4/6/11
9/4/11
9/23/11
12/5/11
1/19/11
4/11/11
5/12/11
4/10/11
4/5/11
5/13/11
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
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Nighttime Tube Feed
Nighttime Tube Feed
Nighttime Tube Feed
Nighttime Tube Feed
Tpn
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Continuous Tube Feed
Renal Diet
Continuous Tube Feed
Continuous Tube Feed
Nighttime Tube Feed, Renal
Tpn/cont tf
Continuous Tube Feed
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