Pearls for Practice: A Novel Tracheostomy Dressing: Extension of a Hydroconductive Wound Dressing

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Thomas L. Wachtel, MD; University of Arizona, Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, Tucson, AZ

  Tracheostomies, which may be acute or chronic, are indicated for different conditions such as chronic obstructive pulmonary disease (COPD); bacterial, viral, or fungal pneumonia; smoke inhalation; and head injury,1 to name a few. The secretions exiting or being suctioned from the tracheostomy site associated with each of these conditions have unique characteristics2; the exudate can be copious, watery bronchorrhea; bloody; viscous; and/or contain varying amounts of exudate, debris, bacteria, and chemicals depending on the etiology of the tracheostomy. A tracheostomy to relieve thick secretions in a case of severe bacterial pneumonia will have exudate heavily laden with bacteria.3 A tracheostomy performed for COPD may have injurious cytokines and proteases in the exudate removed from it.4 A tracheostomy performed to aid in the treatment of smoke inhalation will yield debris such as carbon particles and inflammatory cytokines.5

  Historically, passive absorptive dressings such as gauzes, hydrofibers, foams, and alginates have been used to absorb the exudate coming from the tracheostomy. Silver has been added to some dressings to function as an antimicrobial to prevent infection from the surrounding skin. Recently, a new tracheostomy dressing, Drawtex Tracheostomy Dressing (SteadMed Medical LLC, Fort Worth, TX) was developed using the same LevaFiber technology of the Drawtex wound dressing that has been demonstrated to draw the exudate, debris, bacteria, and cytokines into the dressing while preventing maceration to surrounding skin.6-8 The dressing is designed specifically for tracheostomy care. It has a hole with radial cuts to allow a snug fit around all varieties of tracheostomy tubes, whether plastic, silicone, or metal. The dressing can be used with single-lumen, double-lumen, cuffed, and uncuffed tubes. To facilitate placement, the interlocking cuts are spread and the dressing snugly placed around the tracheostomy tube (see Figure 1). Once in place, the interlocking cuts are refitted to hold the dressing in place. This dressing works well with a chronic metal tracheostomy tube (see Figure 2), as well as with a Silastic tracheostomy tube in the acute tracheostomy situation (see Figure 3).

  The new hydroconductive tracheostomy dressing was evaluated in two different clinical scenarios: one in the hospital setting to evaluate acute tracheostomies and one in the home setting to evaluate the chronic mature tracheostomy. The dressing proved effective in both acute and chronic tracheostomy cases. It drew in the exudate, debris, bacteria, and chemicals and prevented peristomal maceration. In the home scenario, it was easy to use while showering (see Figure 4). The interlocking configuration provides a snug dressing fit around all types of tracheostomy tubes.

Acknowledgment

  The author acknowledges the help of Cynthia Garcia (photographer), R Vance Nesbitt (medical simulations coordinator), and CJ Cowart (photographer), Medical Simulation Lab, Scottsdale Healthcare, Scottsdale, AZ.

Pearls for Practice is made possible through the support of SteadMed Medical, LLC, Fort Worth, TX (www.steadmed.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and not necessarily those of SteadMed Medical, LLC, OWM, or HMP Communications.

This article was not subject to the Ostomy Wound Management peer-review process.

References: 

1. Durbin CG. Indications and timing for tracheostomy. Resp Care. 2005;50:483–487.

2. Dennis-Rouse MD, Davidson JE. An evidence-based evaluation of tracheostomy care practices. Crit Care Nurs Q. 2008;31(2):150–160.

3. Darling D. Tracheostomy. In: The Encyclopedia of Science, Health, & Disease. Available at: www.Daviddarling.info/encyclopedia/T/tracheostomy.html. Accessed December 16, 2012.

4. Thorley AJ, Tetley TD. Pulmonary epithelium, cigarette smoke, and chronic obstructive pulmonary disease. Int J Chron Obstruct Pulm Dis. 2007;2:409–428.

5. Demling RH. Smoke inhalation lung injury: an update. ePlasty. 2008;8:e27.

6. Robson MC. Advancing the science of wound bed preparation for chronic wounds. Ostomy Wound Manage. 2012;58:10–12.

7. Ochs D, Uberti MG, Donate GA, Abercrombie M, Mannari RJ, Payne WG. Evaluation of mechanisms of action of a hydroconductive wound dressing, Drawtex, in chronic wounds. WOUNDS. 2012;24(9 suppl):3–5.

8. Wendelken M, Lichtenstein P, DeGroat K, Alvarez O. Detoxification of venous ulcers with a novel hydroconductive wound dressing that absorbs and transports chronic wound fluid away from the wound. WOUNDS. 2012;24(9 suppl):11–13.

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