Tracheostomy patients Are we really their voice Tracheostomy
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Tracheostomy patients: Are we really their voice? Tracheostomy Discussion Group EBP Extravaganza December 18 th 2007 Amy Nelms & Beth King
Highlights 2007 l Completed 2 CATs. . . almost! l Changing practice on the shop floor l Planning for 2008
Beginnings of clinical questions!
Passy Muir Valves
Beginnings of clinical questions! l 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?
Evidence: Clinical question l In ventilated tracheostomy patients, do Passy Muir valves reduce the time of mechanical ventilation?
Passy Muir Valve
PMV’s reduce time MV? l Frey, JA et al. 1991 Level IV evidence (below) Clinical bottom line: Placement of PMV may assist weaning of some respiratory patients to independently GREAT…but what does tolerate CPAP mode. it mean?
Evidence: Clinical questions l Does an inflated cuff exacerbate/increase aspiration at the level of the vocal folds?
Inflated cuff exacerbate/increase aspiration? l Davis et al 2002 Level IV evidence l Clinical bottom line: Cuff inflation may exacerbate/increase aspiration at the level of the vocal folds and an MBS should be pursued. NEWS FLASH – EVIDENCE GROWS DAILY!!!!
New evidence to critique l ASHA conference 2007 Skoretz. 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
Changes in Practice = EBP + Discussion + clinical experience + time! What are TDG doing?
Changes in Practice l 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
Changes in Practice l 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).
Changes in Practice l 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
Changes in Practice l Are you involved with ventilated patients? ¡ ¡ l 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
Tracheostomy patients: Are we really their voice?
Future directions l Critical care and tracheostomy discussion & EBP group Amy. nelms@email. cs. nsw. gov. au Beth. king@sswahs. nsw. gov. au
- Antigentest åre
- Future simple passive
- Active and passive voice pattern
- Passive froms
- Active passive tense change chart
- Aktiv passiv voice
- Passive voice to active voice converter
- Their pain your voice
- Tracheostomy
- Capping a trach
- St george tracheostomy
- Tracheostomy stoma
- Tracheostomy care
- What size suction catheter to use for tracheostomy
- Tracheostomy oxygen delivery
- Tracheostomy indication and contraindication
- Summary of tracheostomy care
- Dekanylering trakeostomi
- Double lumen tracheostomy tube with cuff