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

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Presentation on theme: "Tracheostomy patients: Are we really their voice? Tracheostomy Discussion Group EBP Extravaganza December 18 th 2007 Amy Nelms & Beth King."— Presentation transcript:

1 Tracheostomy patients: Are we really their voice? Tracheostomy Discussion Group EBP Extravaganza December 18 th 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 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 Inflated cuff exacerbate/increase aspiration? Davis et al 2002 Level IV evidence 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!!!!

11 New evidence to critique 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

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


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