1 / 18

Tracheostomy patients: Are we really their voice?

Tracheostomy patients: Are we really their voice?. Tracheostomy Discussion Group EBP Extravaganza December 18 th 2007 Amy Nelms & Beth King. Highlights 2007. Completed 2 CATs...almost! Changing practice on the shop floor Planning for 2008. Beginnings of clinical questions!.

belkisj
Download Presentation

Tracheostomy patients: Are we really their voice?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Tracheostomy patients:Are we really their voice? Tracheostomy Discussion Group EBP Extravaganza December 18th 2007 Amy Nelms & Beth King

  2. Highlights 2007 • Completed 2 CATs...almost! • Changing practice on the shop floor • Planning for 2008

  3. Beginnings of clinical questions!

  4. Passy Muir Valves

  5. Beginnings of clinical questions! • Company claims‘ Passy Muir Valves aid in the weaning process’…It is considered negligent not to provide a valve…denying the right of communication. What does the literature say?

  6. Evidence: Clinical question • In ventilated tracheostomy patients, do Passy Muir valves reduce the time of mechanical ventilation?

  7. Passy Muir Valve

  8. PMV’s reduce time MV? • Frey, JA et al. 1991 Level IV evidence (below) Clinical bottom line:Placement of PMV may assist weaning of some respiratory patients to independently tolerate CPAP mode. GREAT…but what does it mean?

  9. Evidence: Clinical questions • Does an inflated cuff exacerbate/increase aspiration at the level of the vocal folds?

  10. NEWS FLASH – EVIDENCE GROWS DAILY!!!! Inflated cuff exacerbate/increase aspiration? • Davis et al 2002Level IV evidence • Clinical bottom line: Cuff inflation may exacerbate/increase aspiration at the level of the vocal folds and an MBS should be pursued.

  11. New evidence to critique • ASHA conference 2007Skoretz. S & Coyle. J – Assessment of patients with tracheostomy: Dispelling the myths.Ding & Logemann (2005): Inflated cuff status leads to significant increased frequency of silent aspiration and less hyolaryngeal elevation

  12. Changes in Practice Changes in Practice = EBP + Discussion + clinical experience + time! What are TDG doing?

  13. Changes in Practice • Do you use blue dye in your assessment? • 63% No • 37% Yes, as an adjunct to bedside swallowing assessment • This is a big change in our clinical practice, because of a CAT completed by the TDG

  14. Changes in Practice • Do you use Modified Barium Swallow (MBS) or Flexible Endoscopic Evaluation of Swallowing (FEES)? • Varies • FEES appears to be used with more acute patients, MBS down the track • Many CAP’s/CAT’s indicate MBS or FEES is necessary for accurate assessment of a patient with a tracheostomy. There are practical issues with adopting this EBP (eg very unwell patients in ICU can’t always be transported to x-ray for an MBS).

  15. Changes in Practice • Do you use a cap or speaking valve during oral intake? • 88% Yes, usually a Passy Muir Speaking Valve • Majority of the group adopting EBP based on a CAT

  16. Changes in Practice • Are you involved with ventilated patients? • 75% Yes: for feeding, weaning and communication • Earlier intervention by SP’s • Do you use a Passy Muir Speaking Valve to assist weaning from the ventilator? • Of those SP’s involved with ventilated with patients, ALL are trialling PMSV to assist with weaning • Based on most recent CAP done by the TDG

  17. Tracheostomy patients: Are we really their voice?

  18. Future directions • Critical care and tracheostomy discussion & EBP group Amy.nelms@email.cs.nsw.gov.au Beth.king@sswahs.nsw.gov.au

More Related