From the Guidelines
Treatment of a non-healing tracheostomy site should prioritize proper wound care, infection control, and addressing underlying factors to minimize morbidity, mortality, and improve quality of life. The management of such sites involves daily cleaning with sterile saline or mild antiseptic solutions, application of appropriate dressings, and consideration of topical or systemic antimicrobials when necessary 1.
Key Considerations
- Daily cleaning of the site with sterile saline or mild antiseptic solutions like 0.5% chlorhexidine is essential.
- Application of appropriate dressings such as hydrocolloid, foam, or alginate dressings depending on wound characteristics is recommended.
- For infected sites, topical antimicrobials like silver sulfadiazine or mupirocin may be used.
- Systemic antibiotics are reserved for cases with clear signs of infection.
- Maintaining proper tracheostomy tube positioning and using a correctly sized tube are crucial to prevent pressure necrosis, as emphasized by the need to select a tracheostomy tube of the proper diameter, length, and curvature for the individual patient to minimize potential complications 1.
Additional Recommendations
- Regular tube changes every 1-2 weeks can help reduce biofilm formation.
- Nutritional support is essential, with recommendations including protein intake of 1.2-1.5 g/kg/day and adequate vitamin C, zinc, and other micronutrients to promote healing.
- For persistent non-healing sites, advanced therapies like negative pressure wound therapy or consultation with wound care specialists may be necessary. These interventions are critical in maintaining a clean wound environment, controlling bacterial colonization, reducing pressure on tissues, and supporting the body's natural healing processes, ultimately aiming to reduce morbidity, mortality, and improve the patient's quality of life.
From the Research
Treatment Recommendations for Non-Healing Tracheostomy Site
- The use of moist dressings has been shown to be beneficial in reducing the incidence of site infection and pressure ulcers, as well as shorter wound closing times and lower dressing change frequency 2.
- Clean tracheotomy care has been found to be more effective than sterile care in reducing postoperative pulmonary infection 3.
- Standardization of perioperative tracheostomy care procedures, including the use of hydrocolloid dressings, removal of plate sutures, and placement of polyurethane foam dressings, can decrease the incidence of hospital-acquired tracheostomy-related pressure ulcers 4.
- Proper care and management of tracheostomy sites, including effective mobilization of secretions and prevention of complications such as infection and skin breakdown, are crucial in promoting healing 5.
- The timing and technique of tracheostomy, as well as the use of tracheostomy teams and standardized protocols, can also impact outcomes and reduce the risk of complications 6.
Key Considerations
- The use of suction catheters and functional suctioning systems is essential in preventing complications and promoting healing 5.
- The placement of a tracheostomy tube should be done with careful consideration of the patient's individual needs and medical history 6.
- Regular monitoring and assessment of the tracheostomy site are necessary to identify and address any potential complications or issues 5, 2, 4.