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TRACHEOSTOMY CLINICAL AUDIT

Assessment of indication, management


and decanulation of tracheostomised
patients in Sterling Hospital Rajkot.
• Lead Consultant
• Dr. Sanklap Vanzara
• Dr. Kamal Parikh

• Medical Data Advisor


• Dr. Praful Dharani

• Clinical Data Auditor


• Dr. Vishal Bhatt
• Dr. Vihang Dhebar
• Dr. Bhargavi Vaishnav
AS PER HOSPITAL POLICY WE ARE TAKING
WRITTEN CONSENT FOR EVERY INVASIVE
PROCEDURE
100% (50/50) PT .WERE TAKEN CONSENT

100%
INDICATION

23
25 18
20

15 9

10

0
AIRWAY PROLONG BOTH
PROTECTION VENTILATION
INDICATION VS TIMING
15
16
14
12 9
10 7
8 6 6
6
4 2 2 1 2
2
0
3-7 0-72 >7 3-7 0-72 >7 3-7 0-72 >7
days hours days days hours days days hours days
Airway Protection Prolong ventilation Prolong
Ventilation/Airway
protection
TIMING
19
18
20

18

16 13

14

12

10

0
> 7 days 0-72 hours 3-7 days
10
12
14
16

0
2
4
8
6
Airway Protection

2
Prolong ventilation

> 7 days
Prolong Ventilation/Airway

2
protection

Airway Protection
15

Prolong ventilation
2

0-72 hours
Prolong Ventilation/Airway
1

protection

Airway Protection
6

Prolong ventilation
7

3-7 days
TIMING VS INDIACTION

Prolong Ventilation/Airway
6

protection
T'STOMY DONE BY WHICH SPECIALITY

14%

16%
42% ENT
NEURO SURGEON
ONCO SURGEON
SURGEON

28%
T'STOMY DONE AT

3, 6%

MICU
14, 29% 20, 41%
NICU

OT

SICU

12, 24%
T'STOMY DONE AT V/S BY
18
18

16

14
12
12

10

8 7

6 5

4 3
2
2 1 1

0
ENT ONCO SURGEON NEURO NEURO ONCO SURGEON ENT
SURGEON SURGEON SURGEON SURGEON
MICU NICU OT SICU
ON VENTILATION OR NOT
70 % PT. WAS ON VENTILATOR

30%

No
Yes

70%
PT NOT ON VENTILATION
15 PT. WAS NOT ON VENTILATOR
7

6
5

3 2

2 1

0
ENT NEURO SURGEON ONCO SURGEON SURGEON
SPECIALITY
No
INDICATION
OUT OF 15 ,
1
14 T'STOMY DONE FOR
AIRWAY PROTECTION
AND

1 T'STOMY DONE FOR


AIRWAY PROTECTION
AS WELL AS PROLONG
VENTILATION

14

14
T'STOMY NOT CHANGED TILL
DECANNULATION OR DISCHARGE
35
36 PT DID NOT REQUIRED TUBE CHANGE AVERAGE 8.6944
MEDIAN 7 29
30

25
25

20
20
DAYS

15 15 15
15 14 14
13
11 11 11
10 10
10
8 8
7 7 7 7 7
6 6 6 6 6
5
3 3 3
2 27 2 8.69
1 1 1 1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
T'STOMY CHANGED DAYS
14 PT. REQUIRED TUBE CHANGED
45 AVERAGE 11.714
MEDIAN 9.5
42
40

35

30

25
DAYS

20 18 19 DAYS
11.71
9.5
15 13
10 11 11
10 8 8 9
6
5 3 4
2
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14
T’STOMY NEEDS TO CHANGE ??
T’STOMY NEEDS TO CHANGE IN 14 PT.

36 14
NEEDS TO CHANGE

NO NEEDS TO CHANGE
PLANNED/UNPLANNED
9 T’STOMY CHANGED WERE UNPLANNED

5 9
PLANNED

UNPLANNED
COMPLICATION
1, 6%
3, 17%
2, 12%
Bleeding from stoma and tube
blocked
Bleeding from stoma site
1, 6%
Stoma site infection

Stoma site infection and tube


blocked
2, 12%
Tube Blocked

Tube blocked both the time

8, 47%
LOCATION OF COMPLICATION
LOCATION OF COMPLICATION
5
5
4.5
4
3.5
3
2.5 2
2
1.5 Total
1 1 1 1 1 1 1 1
1
0.5
0
Stoma Bleeding Tube Tube Bleeding Tube Tube Stoma Tube Tube
site from Blocked blocked from Blocked blocked site Blocked blocked
infection stoma site both the stoma both the infection both the
and tube time and tube time and tube time
blocked blocked blocked
Burns ICU MICU MICU/Wards NICU Ward
LOCATION OF TUBE BLOCKED
LOCATION OF TUBE BLOCKED
5
5

3
2
2
1 1 1 1 1 1 1 1
Total
1

0
Stoma Bleeding Tube Tube Bleeding Tube Tube Stoma Tube Tube
site from Blocked blocked from Blocked blocked site Blocked blocked
infection stoma site both the stoma both the infection both the
and tube time and tube time and tube time
blocked blocked blocked
Burns ICU MICU MICU/Wards NICU Ward
DECANNULATION RATIO
12/50 PT. WERE DECANNULATION TRIAL GIVEN

12

38
SUCCESSFUL DECANNULATION
10/12 PT. WERE SUCCESSFULLY DECANULATED
AND
1 PT. WAS SUCCESSFULLY DECANULATED IN 2nd ATTAMPT

9
9
8
7
6
5
4
2
3
2
1
1
0
Yes Not Successful Yes Not Successful for 1st Yes Successful
time(Ecessive secretion)
Successful for 2nd time
TYPE OF DISCHARGE
13

28

Discharge
Expired
LAMA

9
DISCHARGE/LAMA WITH T'STOMY ?
18

18 13
16
10
14

12

10

0
No Discharge Yes Discharge Yes LAMA

Total
1 Stoma site infection and tube
blocked
2 Stoma site infection
3 Stoma site infection and tube
blocked
DONE DECANNUL TYPE OF WITH
NO. NAME DIAGNOSIS DONE BY INFECTION
AT ATION DISCHARGE T'STOMY

Accidental Electrical Burns


(35-40%) with B/L BE Stoma site
Dr.
Kantibhai amputaion with both eye infection Successfu
1 Kaushik OT Discharge No
Rathod injury with paraplagia with and tube l
Kotak
B/L pnumonia respi failure blocked
with bronchiectasis

Head Injury with Lt. FT


SAH with Temporal SDH Dr. Not
Navnitbhai Stoma site
2 and Hemorragic contusion Sanjay NICU Successfu Discharge Yes
Khachar infection
with Lt. zygomic arch, Tilala l
aspiration pneumonia

Lt. MCA acute infarct with lt


Stoma site
supralinoidal ICA Dr.
Balsinh infection
3 thrombotic occlusion with Sanjay NICU __ LAMA Yes
Sarvaiya and tube
B/L pneumonitis with ARDS Tilala
blocked
with respi failure with AF