Identifying contributing factors to tracheostomy stoma breakdown: A retrospective audit in a single adult intensive care unit

Introduction Tracheostomies are a common adjunct to therapy for critically ill patients in the intensive care unit (ICU). This study sought to identify the incidence of, and demographic, clinical and care process factors related to, tracheostomy-related skin injuries (TRSI) in ICU patients.

Methods Conducted in a 36-bed ICU of an Australian metropolitan tertiary referral acute care health facility, this study employed a retrospective review of patient records between February 2015 and December 2016 for patients who had a tracheostomy inserted during an ICU admission. Records were reviewed for the patient’s admission or a 20-day observation period, whichever was shorter.

Results Of the 102 patients included, 66 were male (64.7%) and their mean age was 50 years (SD=18.3). Of these patients, 23 (22.5%) developed a TRSI. No association was found between patient characteristics, tracheostomy insertion method and the development of a TRSI; however, the use of non-adjustable flange tubes was associated with the development of TRSI (p=0.023). Omissions in nursing documentation of care processes for tracheostomies were observed.

Conclusion This study addressed a specific medical device, the tracheostomy tube, providing evidence of TRSI occurrence in the ICU setting. Although no common demographic, clinical nor care process factors were associated with TRSI development, findings from this study highlight a deficiency in nursing documentation.