Résumé :
|
Background : The Victorian Respiratory Support Service (VRSS) currently has 640 clients using ventilators and bi-level devices to manage respiration in a wide range of diseases resulting in respiratory failure. Approximately 5% have permanent tracheostomy tubes for airway protection in the presence of bulbar dysfunction and/or to provide 24-hour ventilation. The VRSS Outreach Service monitors the management of tracheostomy tubes and performs tube changes in clients living in the community. The Outreach Nurses hold a weekly tracheostomy clinic at which approximately 40% of 2nd monthly tube changes are performed. There are a number of clients for whom travelling to the hospital for a brief clinic visit is impractical and these tube changes are done at the clients' homes, Nursing Homes or Community Houses. Method : Chart review of all tracheostomy tube changes performed by the VRSS Outreach Nurses over the last 10 years. Results : the Outreach Nurses have performed 871 tracheostomy tube changes. Of these 370 were done at tracheostomy clinic, 345 at clients' homes and 156 at institutions such as Nursing Homes and Community Houses. On 61 occasions tracheostomy tubes were changed early; 28 as a result of cuff or pilot balloon failure, 21 as a result of partial tube blockage in the presence thickened secretions and 6 as a result of client discomfort. In the remaining 5 cases the clients were admitted to hospital for tube change via bronchoscopy, 4 as a result of tracheomalacia and 1 after the tube was accidentally dislodged. Conclusion : Admission to hospital was required in only 0.6% of tracheostomy tube changes over the last 10 years. The VRSS practice providing comprehensive training for carers, involving the GP in the clients' health care and utilising an Outreach Service to provide ongoing support and education allows for successful management of ventilator dependent people with tracheostomy in a community setting.
|