Oral Cancer, Post-Tracheostomy Care, Tracheostomy, Tracheostomy Complications
Conditions
Keywords
Novel Tracheostomy Tube Fixation Device, Tracheostomy Tube Fixation, Tracheostomy Care, Airway Rehabilitation, Nursing Efficiency, Complication Rate, Patient Comfort, Tracheostomy Wound Care, Cervical Skin Injury, Tube Displacement, Oral Cancer Patients, Randomized Controlled Trial
Brief summary
This study evaluated a novel tracheostomy tube fixation device in post-tracheostomy patients with oral cancer. After tracheostomy, conventional fixation methods may be associated with skin pressure injury, wound contamination, frequent dressing changes, tube displacement, and patient discomfort. The novel fixation device was designed to provide stable tube fixation, protect the cervical skin, facilitate wound care, and improve patient comfort. A total of 150 eligible patients who underwent tracheostomy were randomly assigned to a treatment group or a control group. Patients in the control group received routine tracheostomy care and conventional fixation. Patients in the treatment group received the novel self-adhesive bidirectional tracheostomy tube fixation device in addition to routine tracheostomy care. The study assessed whether the novel fixation device could reduce tracheostomy-related complications, improve nursing efficiency, reduce the frequency and duration of wound care, improve neck comfort, and maintain safe tracheostomy tube fixation.
Detailed description
Tracheostomy is commonly performed in patients who require airway management after oral and maxillofacial head and neck tumor surgery. Stable fixation of the tracheostomy tube and appropriate wound care are important for maintaining airway safety, reducing local complications, and improving patient comfort. Conventional fixation methods, such as gauze ties or routine fixation straps, may become contaminated by blood or secretions, may cause friction or pressure on the cervical skin, and may require frequent replacement. These issues can increase nursing workload and may contribute to local skin injury, infection, tube displacement, or patient discomfort. This randomized controlled trial was designed to evaluate the clinical application value and efficacy of a novel self-adhesive bidirectional tracheostomy tube fixation device. The device is intended to provide stable tracheostomy tube fixation while facilitating wound observation, dressing replacement, and daily nursing care. Eligible patients were post-tracheostomy patients with oral cancer who were conscious, had adequate comprehension and communication ability, had intact cervical skin without infection or skin disease, and provided informed consent. Patients with pre-existing pressure injury, skin damage, allergy, or infection in the anterior cervical region before tracheostomy, pregnant women, minors, and patients with psychiatric disorders were excluded. Participants were randomly assigned to two groups. The control group received routine tracheostomy care, including conventional tube fixation, nebulization therapy as prescribed, sputum suctioning as needed, regular inner cannula cleaning, and routine sterile gauze dressing care. The treatment group received routine tracheostomy care plus the novel self-adhesive bidirectional tracheostomy tube fixation device. The device was replaced once daily, or earlier if blood or exudate soaked two-thirds of the device. The primary outcome was the occurrence of infection or inflammatory signs around the tracheostomy wound, including redness, swelling, heat, and pain. Secondary outcomes included the frequency of device or dressing replacement, duration of each wound care procedure, new cervical skin injury, tracheostomy tube displacement, and patient-reported neck comfort. Safety assessments included changes in oxygen saturation before and after use and the recording of adverse events, including tube dislodgement. The purpose of this study was to determine whether the novel tracheostomy tube fixation device could improve nursing efficiency, reduce tracheostomy-related complications, and improve patient comfort compared with conventional fixation and routine tracheostomy care.
Interventions
DEVICENovel Self-Adhesive Bidirectional Tracheostomy Tube Fixation Device
The novel self-adhesive bidirectional tracheostomy tube fixation device was used for tracheostomy tube fixation in addition to routine tracheostomy care. After drying the wound area, the device was placed between the patient and the tracheostomy tube, with the posterior side attached to the cervical skin. The anterior hook-and-loop components were passed through the fixation wings of the tracheostomy tube and adjusted to secure the tube. The device was replaced once daily, or earlier if blood or exudate soaked two-thirds of the device.
OTHERRoutine Tracheostomy Care and Conventional Fixation
Routine tracheostomy care included conventional tracheostomy tube fixation, nebulization therapy as prescribed, sputum suctioning as needed, regular cleaning or replacement of the inner cannula, and sterile gauze dressing care. Conventional fixation was performed using gauze ties or routine fixation straps around the neck with appropriate tightness. The tracheostomy wound dressing was changed twice daily or earlier if blood or exudate soaked two-thirds of the gauze dressing.
Sponsors
Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
This was an open-label study because the tracheostomy tube fixation method was visible to both participants and care providers. No masking was implemented.
Intervention model description
This is a two-arm, parallel, randomized controlled trial. Eligible post-tracheostomy patients were randomly assigned to either the treatment group or the control group. The control group received routine tracheostomy care and conventional fixation, while the treatment group received routine tracheostomy care plus a novel self-adhesive bidirectional tracheostomy tube fixation device.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged 18 years or older. * Patients with oral cancer who underwent tracheostomy or required a tracheostomy tube during hospitalization. * Patients who were conscious and had normal comprehension and communication ability. * Patients with intact cervical skin without skin damage, skin disease, or infection. * Patients who voluntarily agreed to participate and provided written informed consent.
Exclusion criteria
* Patients with pre-existing pressure injury, skin damage, allergy, or infection in the anterior cervical region before tracheostomy. * Pregnant women. * Minors under 18 years of age. * Patients with psychiatric disorders. * Patients who were unable to cooperate with the study procedures or outcome assessments as judged by the investigators.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Tracheostomy Wound Infection | From intervention initiation to hospital discharge, up to 14 days | The occurrence of infection or inflammatory signs around the tracheostomy wound was assessed, including redness, swelling, heat, and pain around the tracheostomy site. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of Dressing or Device Replacement | From intervention initiation to hospital discharge, up to 14 days | The number of dressing or fixation device replacements was recorded. Replacement was performed once daily or earlier if blood or exudate soaked two-thirds of the dressing or device. |
| Duration of Each Dressing or Device Replacement Procedure | From intervention initiation to hospital discharge, up to 14 days | The time required for each dressing or fixation device replacement procedure was recorded. Timing started when the dressing or device replacement began and ended after the fixation device or dressing was properly adjusted and secured. |
| Incidence of New Cervical Skin Injury | From postoperative day 1 to hospital discharge, up to 14 days | New cervical skin injury around the tracheostomy tube fixation area was recorded, including newly developed pressure injury, skin redness, skin breakdown, or other fixation-related skin damage. |
| Incidence of Tracheostomy Tube Displacement | From intervention initiation to hospital discharge, up to 14 days | Tracheostomy tube displacement was assessed by marking the skin incision site as 0 cm. Tube movement of 0.8 cm or less was considered displacement according to the study protocol. |
| Patient-Reported Neck Comfort Score | From intervention initiation to hospital discharge, up to 14 days | Patient-reported neck comfort was assessed using a 0-to-10 scale. Conscious patients were asked to describe their wearing experience, with scores of 0 to 2 indicating comfort and scores of 3 to 10 indicating discomfort. |
Countries
China
Outcome results
None listed