Though nursing and physician training is comprehensive, RTs have more specialized knowledge in the respiratory system and many believe the job of airway clearance and tracheostomy care should fall to them.
By Phyllis Hanlon
If you’ve ever watched an assembly line in action, you’ve seen that precision gets results. Every person on that line has a specific job and excels in that particular task. In a hospital setting, specialized care from trained, knowledgeable professionals also achieves positive outcomes. As a respiratory therapist, you’ve absorbed a massive amount of material about the pulmonary system through education and hands-on care. So doesn’t it make sense that the responsibility for airway clearance should fall to you?
In 2002, the Department of Nursing at Walter Reed Army Medical Center (WRAMC) conducted a pilot study1 on tracheostomy/suctioning care to adapt “the hospital’s existing performance improvement model to better facilitate evidence-based practice.” Surveys on tracheostomy had shown an inconsistent level of knowledge and a variation in clinical practice in nursing staff, representing “a patient safety threat in the form of nosocomial infections, prolonged hospitalizations, airway complications, and even death.”
Now consider the training and education a respiratory therapist receives. RTs have an in-depth understanding of all aspects of tracheostomy care. Chrishuna Vasser, RRT, who works at UAB Hospital, Riverview Regional Medical Center in Birmingham, Ala, asserted that a respiratory therapist’s role is to manage and treat all aspects of care for patients with cardiopulmonary disorders.
“In caring for tracheostomy patients, it is critical for the respiratory therapist to maintain the airway, assess and minimize bronchial secretions, and maintain the site surrounding the tracheostomy from skin breakdown,” Vasser said. “The assessment of the tracheostomy patient will be important for the respiratory therapist to document and report. RTs should provide care to the tracheostomy patient that will cause the least amount of distress.”
For example, tracheostomy patients should be hyper-oxygenated prior to suctioning; a suctioning pass should last no longer than 15 seconds, followed by manual ventilation. RTs are trained in this process, while nursing sometimes fails to realize that suctioning too frequently will irritate and traumatize the mucosal membranes, according to Vasser. She added that auscultating breath sounds before and after a suctioning procedure is another key part of the process.
Theresa McGauley-Keaney, MPA, RRT, program monitor and trainer and respiratory care consultant at UMass Medical School in Worcester, Mass, acknowledged that nursing and physician training is comprehensive, but pointed out that RTs have more specialized knowledge in the respiratory system. “Generally speaking, I believe this skill should be performed by respiratory therapists as best practice. It improves patient safety and diminishes the risk of adverse events for the institution,” said McGauley-Keaney.
“A thorough understanding of what is going on internally is essential for anyone who performs tracheostomy care,” she added. “This puts it squarely in the wheelhouse of respiratory therapists. Quick identification and remedy of a problem is required to prevent mortality and morbidity.”
Tracking infection rates on patients with tracheostomies might convince hospitals to designate RTs as the clinical specialist for this type of care, according to Elizabeth Kelley Buzbee, RRT-NPS, RCP, respiratory care instructor at Lone Star College–Kingswood, in Houston.
“I know that once hospitals gave central line care to a central line specialist nurse, the rates of infections went down, because, with a smaller dedicated group, you now had training, experience, and, most important, accountability. We should see similar results with a dedicated tracheostomy care team,” Buzbee said, adding that nurses may relinquish the task readily, since many don’t feel comfortable with this care and have more than enough to do already.
Phyllis Hanlon is a contributing writer to RT. For further information contact [email protected].
1. Henriksen K, Battles JB, Marks ES, et al, editors. A New Model of Tracheostomy Care: Closing the Research–Practice Gap. Rockville, Md: Agency for Healthcare Research and Quality (US); 2005 Feb Accessible from: http://www.ahrq.gov/downloads/pub/advances/vol3/clair.pdf