From the Guidelines
A tracheostomy site must be at least 7-10 days old before it is considered mature enough for safe tube changes. This initial period allows the tract between the skin and trachea to form and stabilize, reducing the risk of serious complications such as loss of the airway, false passage creation, subcutaneous emphysema, or inability to reinsert the tube 1. The tracheostomy procedure in children is typically an open surgical procedure, and due to the small tracheal diameter, pediatric tracheostomy tubes are generally uncuffed and do not have an inner tube, to avoid reducing the internal diameter of the tracheostomy tube lumen further 1.
Some key considerations for tracheostomy site maturity include:
- The use of 'maturation sutures' to accelerate the process of stoma maturation 1
- The presence of 'stay sutures' on either side of the vertical tracheostomy to aid opening of the lumen in an emergency, before the planned first tube change 1
- The importance of having experienced personnel present with appropriate equipment, including suction, oxygen, and emergency airway supplies, for the first tube change 1
After the tract has fully matured, typically after 2-3 weeks, tube changes become safer and can be performed more routinely 1. The maturation process involves epithelialization of the tract, which creates a stable channel between the skin surface and the trachea. In emergency situations where a tube must be changed before maturity, extra caution and specialized techniques may be required to ensure patient safety.
From the Research
Tracheostomy Site Care
- The age at which a tracheostomy site can be considered stable is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that tracheostomy care is crucial to maintain airway patency, minimize infection, and ensure skin integrity around the tracheostomy stoma to prevent complications 5.
- The decision to perform a tracheostomy is typically made within 7-10 days of identifying the need for prolonged airway access 2.
- There is no general consensus on the timing of tracheostomy in pediatric patients, but surgical tracheostomy is described as a safe procedure with emphasis on safety measures to minimize complications 3.
- Post-operative tracheostomy care is discussed for the early and late post-operative periods, but there is no general consensus on decannulation protocols 3.
Tracheostomy Care and Complications
- Tracheostomy care includes stoma care and tracheostomy suctioning, and using evidence-based recommendations can limit variation in practice and lead to better patient outcomes 5.
- The role of the nurse in caring for patients before, during, and after tracheostomy insertion is crucial, including the management of tracheostomy-related complications and emergencies 6.
- Wound infection is a potential complication of tracheostomy, and antibiotic prophylaxis may reduce the risk of wound infection, although the evidence is not statistically significant 4.