From the Guidelines
For a post-operative tracheostomy and PEG tube patient, it is crucial to monitor for several key complications to prioritize morbidity, mortality, and quality of life. The most recent and highest quality study 1 emphasizes the importance of a coordinated, systematic approach to caring for patients with a tracheostomy, highlighting the need for multidisciplinary teamwork, standardization, education, and patient partnership to improve patient safety and quality of care.
Key Complications to Monitor
- Tracheostomy-related issues:
- Bleeding around the site
- Tube displacement or obstruction
- Infection (redness, swelling, purulent discharge)
- Subcutaneous emphysema
- Tracheal stenosis
- PEG tube-related issues:
- Signs of infection at the insertion site
- Leakage around the tube
- Tube displacement or blockage
- Buried bumper syndrome
- Feeding tolerance:
- Abdominal distension
- Vomiting
- Diarrhea
- Skin integrity:
- Proper cleaning and dressing changes around both sites
- Aspiration pneumonia:
- Monitor for signs of aspiration, which can occur with either procedure
Recommendations for Care
- Ensure proper cuff management to prevent tracheal damage and aspiration 1
- Monitor oxygen saturation and respiratory status, and perform regular suctioning to prevent mucus plugging 1
- Maintain skin integrity around both sites with proper cleaning and dressing changes 1
- Ensure adequate hydration and nutrition, and monitor for aspiration pneumonia, which can occur with either procedure 1
- Regular assessment of both sites should be incorporated into your care routine 1
Best Practices for Patient Safety
- Implement a coordinated, systematic approach to caring for patients with a tracheostomy 1
- Promote multidisciplinary teamwork, standardization, education, and patient partnership to improve patient safety and quality of care 1
- Utilize data collection and analytics to track outcomes and identify areas for improvement 1
From the Research
Post-Tracheostomy and Percutaneous Endoscopic Gastrostomy (PEG) Care
Issues to be monitored in a patient who is post tracheostomy (trach) and PEG include:
- Hemorrhage
- Infection
- Accidental decannulation
- Tube obstruction
- Clogging
- Dislodgement 2
- Respiratory infections, including ventilator-associated pneumonia and infection of the lower respiratory tract, which can occur before or after the tracheostomy procedure 3
- Tracheostomy obstruction, decannulation or tube dislodgement, stenosis, tracheoinnominate fistula, and tracheoesophageal fistula 4
- Sedation use and mobility, as tracheostomy has been associated with less sedation use and earlier mobility compared to continued translaryngeal intubation 5
- Time to decannulation, length of stay, tracheostomy-related adverse events, and other tracheostomy-related outcomes, which can be improved with the use of tracheostomy bundles, tracheostomy teams, and protocol-directed care 6
Monitoring and Management
Monitoring for these issues is crucial to prevent complications and ensure optimal patient care. A multidisciplinary team approach, including the use of tracheostomy bundles and protocol-directed care, can help improve patient outcomes 2, 6. Regular assessment and management of the tracheostomy and PEG tubes, as well as the patient's overall condition, are essential to identify and address any potential issues promptly 2, 4, 5.
Potential Complications
Potential complications, such as respiratory infections, can have significant impacts on patient outcomes, including longer hospital stays and higher costs 3. Therefore, it is essential to be aware of these potential complications and take steps to prevent them, such as implementing infection prevention measures and monitoring for signs of infection 3, 4.