Episode 85: Tracheostomy basics with Vinciya Pandian
Feb 5, 2025
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Vinciya Pandian, an Associate Dean at Penn State and a seasoned tracheostomy nurse practitioner, shares her wealth of knowledge. She discusses the critical factors in evaluating tracheostomy candidates, including medical history and physical assessments. Pandian highlights the importance of pre-procedural communication with patients and families to ensure informed consent. The conversation dives into various techniques for tracheostomy placement and the management of potential complications, offering listeners invaluable insights into best practices in critical care.
Dr. Vinciya Pandian underscores the importance of thorough pre-operative evaluations, including patient history and stability, for safe tracheostomy procedures.
The podcast highlights the vital role of family education and communication about tracheostomy care to ensure informed decision-making and optimal patient support.
Deep dives
Expert Background on Tracheostomy Care
The guest expert, Dr. Vincia Pandian, shares her extensive experience in managing tracheostomy patients, beginning in critical care settings and evolving into specialized roles. She emphasizes the challenges nurses face when caring for tracheostomy patients and recounts her journey from bedside nursing to becoming a nurse practitioner specializing in tracheostomy care. Dr. Pandian highlights her role in the development of a percutaneous tracheostomy team, focusing on quality improvements to enhance patient outcomes. Her personal experiences with her newborn son needing ventilation influenced her perspective on the timing and appropriateness of offering tracheostomies to patients.
Logistical Considerations for Tracheostomy Placement
Deciding who should perform a tracheostomy depends largely on institutional practices and patient specifics, including their medical or surgical history. At Johns Hopkins Hospital, tracheostomies are handled based on ICU specialization, with designated teams providing care based on patient needs and specialties. Dr. Pandian explains that multiple factors must be evaluated pre-operatively, including any surgical history, anatomical considerations, and the patient’s overall stability. This thorough evaluation ensures that the tracheostomy is performed safely and efficiently, whether at the bedside or in the operating room.
Pre-Procedural Steps Before Tracheostomy
Pre-procedural considerations for tracheostomy include evaluating the patient’s anticoagulation status and obtaining informed consent from family members. Dr. Pandian notes the significance of educating families on what to expect, especially when the concept of a tracheostomy is unfamiliar to them. Guidelines for anticoagulation levels, such as maintaining INR and platelet counts within safe ranges, are established to reduce the risk of complications during the procedure. Clear communication with both the patient and family about the risks and benefits is vital for making informed decisions and ensuring optimal care.
Post-Operative Care and Management of Tracheostomies
After a tracheostomy procedure, routine care involves ensuring the tracheostomy tube is patent and managing regular tube changes to prevent infections. Dr. Pandian discusses the timing of initial tube changes and emphasizes the need for consistent care to avoid complications such as decannulation. For fresh tracheostomy stomas, care professionals must assess whether to replace the tube or wait for a specialized team if the patient is unstable. Additionally, maintaining the patency of the tube through effective suctioning and stoma care is critical, as it can prevent serious respiratory issues for the patient.
We discuss the basics of evaluation for tracheostomy placement, periprocedural care, and post-procedure complications with Vinciya Pandian, PhD, ACNP, FCCM, tracheostomy nurse practitioner and researcher. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!
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