Managing an open tracheostomy site with negative pressure wound therapy

Background: Complex patients with multiple co-morbidities often present with fresh surgical tracheostomies that fail to heal.  Classic wound care dressings of gauze may protect from friction but do not absorb moisture and may add to the problem of surface skin infections. Using traditional packing methods such as calcium alginate, gauze, or wound gels, increase risk for aspiration of particulate given that it is an open air way. Recently experts reported a case where negative pressure wound therapy promoted healing at a large and challenging tracheostomy site.

Purpose: The purpose of this presentation is to provide an innovative option for advanced wound healing in a complex patient using negative pressure wound therapy applied to a dehisced tracheostomy site

Methods: In this case study, discussions were held with the Cardiothoracic surgeon who placed the tracheostomy as well as nursing leadership, floor nurses, dialysis nurses, and respiratory therapy, as this method has not been applied in this facility. With low risk to patient, negative pressure wound therapy was applied and the dressings changed three times a week. The tracheostomy site was checked daily by the wound care nurses while respiratory therapy and the bedside nurses monitored the ventilator settings and overall patient response to therapy.  Serial photographs demonstrated slow but steady wound improvement.

Results: The tracheostomy wound site was assessed and photographed with each dressing change, three times a week. After three weeks of therapy, the wound reduced by 87.5% when negative pressure therapy was stopped. The wound healed completely within 7 days using foam dressings. No adverse events were recorded by clinical nurses or respiratory therapists. 

Conclusion: Application of negative pressure wound therapy to an open tracheostomy site is a safe and effective approach for patients where traditional wound care options increase the risk for aspiration, infection, or catastrophic events.