Beyond the Collar: An Innovative Approach to Tracheostomy Tube Securement to Promote Optimal Wound Healing

Purpose: The purpose of this case study was to effectively manage an advanced stage pressure injury to the posterior neck of a complex, immobile, tracheostomy/vent dependent patient.

Summary: This complex patient has a diagnosis of SMA type 2. He is immobile, bed bound, and tracheostomy/vent dependent. The hospital’s standard tracheostomy collar contributed to the cause of his stage 3 pressure injury. Effectively offloading this wound while using the standard hospital tracheostomy collar was near impossible. Consistent wound care to this injury was often refused, related to the intense pain he reported during wound care. Using an innovative approach with known wound care products (tube securement devices) and collaborating with his medical team and the facility’s risk management team, a new method of securing his tracheostomy tube was created, approved for use, and then implemented.

Method: Using two hydrocolloid-based tube securement devices, one each attached to the right and left of patient’s tracheostomy stoma. Trach twill ties were threaded through patient’s tracheostomy tube flanges and then threaded through each securement adapter. With respiratory therapy’s approval, a mock-up model was then created and presented to patient’s medical team. With the medical team’s approval, this idea was then presented to the hospital’s risk management team (because this method would not comply with the hospital’s policy of tracheostomy care). Once the risk management team provided approval, the idea was presented to the patient. The patient gave consent to trial the new plan and education was then provided to all bedside staff.

Outcome: Once this innovation was implemented, the patient reported an immediate decrease in pain from 10/10 to 0/10 at the site of his injury. Within a few months, this pressure injury healed entirely. The newly created tracheostomy tube securement device is still in use.