An animal tissue simulation assessing three directional displacement forces on five common tracheostomy securing techniques

• Published in: Annals of the Royal College of Surgeons of England Vol. 100; no. 6; pp. 459 - 463
• Main Authors: Yap, D, Goddard, S, Ng, M, Al-Hussaini, A, Owens, D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.07.2018; Royal College of Surgeons
• Subjects: Airway management; Animals; Biomechanical Phenomena; Intensive care; Laboratories; Methods; Neck; Ostomy; Otolaryngology; Sheep; Studies; Suture Techniques - instrumentation; Tension tests; Tracheostomy - instrumentation; Tracheostomy - methods; Validity; Ventilators; United Kingdom > UK; United States > US; Tracheostomy; Airway management; Torque; Neck; Suture techniques
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2018.0069

Introduction Several methods of securing a tracheostomy tube have been described in the literature including using ties or tapes around the neck and suturing the plastic flange to the neck in various ways. However, there are no wet lab-based studies to objectively determine the force required to displace the tracheostomy tube using different securing techniques. Ours is the first animal tissue simulation study published in the literature. Methods A simulated tracheostomy stoma was created on a sheep neck model. A tracheostomy tube was inserted into the stoma and secured using various methods. Tension tests were conducted to significantly displace the tube from the stoma. Each technique was repeated six times on different sheep necks. All results were analysed using SPSS . Results Repeat measurements indicated that the largest displacement forces come from an oblique direction while the lowest force values were found at the lateral angle. Averages of displacement showed that medially placed sutures required the largest forces in comparison with other securing methods. Wilcoxon signed-rank testing indicated that medial and continuous suture security resists displacement at forces that otherwise displace flange and interrupted sutures. Conclusions This study has shown that any type of securing suture requires a greater displacement force than the strap of the tracheostomy tube holder alone. Medially placed sutures require a greater displacement force than those placed laterally. Displacement in the lateral direction requires the least force in comparison with movement at perpendicular or oblique angles.