Cuidados de traqueostomía para adultos y ancianos en el entorno domiciliario: una revisión de alcance

Cordeiro, Aldenora Laísa Paiva de Carvalho; Santos, Jade Alycia Ribeiro e; Barroso, Ana Clara Leite; Donoso, Miguir Terezinha Vieccelli; Mata, Luciana Regina Ferreira Pereira da; Chianca, Tânia Couto Machado

doi:10.1590/1980-220X-REEUSP-2024-0028en

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REVIEW • Rev. esc. enferm. USP 58 • 2024 • https://doi.org/10.1590/1980-220X-REEUSP-2024-0028en linkcopiar

Cuidados de traqueostomía para adultos y ancianos en el entorno domiciliario: una revisión de alcance

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo: Mapear el conocimiento científico sobre cuidados de traqueostomía para adultos y ancianos realizados por individuos, familias o cuidadores en el entorno domiciliario.

Método: Revisión exploratoria, realizada en febrero de 2023, según la metodología del Instituto Joanna Briggs. La pregunta-guía fue: ¿qué y cómo debe ser realizado el cuidado de la traqueostomía del adulto/anciano por el individuo/familia/cuidador en el ambiente domiciliario? Se consideraron estudios publicados en portugués, inglés y español. Las bases de datos consultadas fueron: Lilacs; Medline, vía PubMed; Cinahl; Cochrane Library; PEDro; Embase; Scopus y Web of Science.

Resultados: Se identificaron 2158 artículos, de los cuales 81 fueron leídos en su totalidad y 14 incluidos en la revisión. Los principales tipos de cuidados identificados incluyeron necesidades psicobiológicas: succión de la vía aérea, cambio del accesorio de traqueostomía, limpieza de la endocánula e higienización de la piel periestomal. En cuanto a las necesidades psicosociales, se identificaron incentivos para la comunicación y la autonomía. No hubo recomendaciones para los cuidados relacionados con las necesidades psicoespirituales.

Conclusión: Los hallazgos priorizan los cuidados biológicos y pocos estudios han detallado cómo llevar a cabo dichos cuidados en el domicilio.

DESCRIPTORES
Traqueostomía; Atención Domiciliaria de Salud; Alta del Paciente; Enfermería

DATABASE	STRATEGY
LILACS	(traqueostomia OR tracheostomy OR traqueostomía OR trachéostomie) AND (“Assistência Domiciliar” OR “Home Nursing” OR “Atención Domiciliaria de Salud” OR “Soins à domicile” OR “Ambiente Domiciliar” OR “Home Environment” OR “Ambiente en el Hogar” OR “Enfermagem Domiciliar” OR “Home Health Nursing” OR “Cuidados de Enfermería en el Hogar” OR “Soins infirmiers à domicile” OR “Home Care”) AND ( db:(“LILACS” OR “BDENF” OR “IBECS” OR “BINACIS” OR “campusvirtualsp_brasil” OR “CUMED” OR “INDEXPSI” OR “MedCarib” OR “SES-SP” OR “SMS-SP” OR “SOF” OR “colecionaSUS”))
MEDLINE VIA PUBMED	(Tracheostomy) AND (“Home Nursing” OR “Home Environment” OR “Home Health Nursing” OR “Home Care”)
CINAHL	(Tracheostomy) AND (“Home Nursing” OR “Home Environment” OR “Home Health Nursing” OR “Home Care”)
COCHRANE	(Tracheostomy) AND (“Home Nursing” OR “Home Environment” OR “Home Health Nursing” OR “Home Care”)
GOOGLE SCHOLAR	(Tracheostomy OR Traqueostomia) AND (“Home Nursing” OR “Assistência Domiciliar”)
PEDro	(Tracheostomy)
EMBASE (Via Portal Capes)	(Tracheostomy) AND (‘Home Care’ OR ‘Home Environment’)
SCOPUS (Via Portal Capes)	(Tracheostomy) AND (“Home Nursing” OR “Home Environment” OR “Home Health Nursing” OR “Home Care”)
WEB OF SCIENCE (Via Portal Capes)	(Tracheostomy) AND (“Home Nursing” OR “Home Environment” OR “Home Health Nursing” OR “Home Care”)
GREY LITERATURE	STRATEGY
CAPES catalog of theses and dissertations	(Traqueostomia) AND (“Assistência Domiciliar”)
OASISBR	(Traqueostomia) AND (“Assistência Domiciliar”)
OpenGrey	(Tracheostomy) AND (“Home Nursing”)

Title	Year/country	Aim	Type of study	Main results
[E1] A systematic review of patient and caregiver experiences with a tracheostomy(¹).	2018, New Zealand.	To understand current knowledge related to the experience and quality of life of adults living with a tracheostomy and their caregivers, in order to improve care.	Systematic review.	Five main themes emerged from the research: (1) care, support and management of a tracheostomy; (2) speech and communication; (3) well-being and quality of life; (4) disfigurement and body image; and (5) stigma and social isolation.
[E2] Descripción y manejo del paciente traqueostomizado en Hospitalización Domiciliaria: experiencia en el Complejo Asistencial Doctor Sótero del Río (Description and management of the tracheostomized patient in home hospitalization: experience in the Complejo Asistencial Doctor Sótero del Río.)(¹¹).	2022, Chile.	To describe the profile and management of patients with tracheostomies who are hospitalized at home.	Descriptive, retrospective.	The objective of teaching tracheostomy management and education was applied to 87 of the 96 participating patients and covered general tracheostomy and stoma care, knowledge of the device and management of emergencies and decannulation situations.
[E3] Cuidados para a prevenção de complicações em pacientes traqueostomizados (Care to prevent complications in tracheostomized patients(¹²).	2019, Brazil.	To analyze the evidence of care for the prevention of complications in tracheostomized patients.	Integrative review.	Factors related to endotracheal suction, tube and skin cleanliness and health education were the main strategies for minimizing the risk of complications.
[E4] As necessidades de aprendizagem dos pacientes laringectomizados (The learning needs of laryngectomized patients)¹³).	1992, Brazil.	Reporting on the learning needs of laryngectomized patients treated at a university hospital.	Qualitative, participant observation.	The learning needs identified refer to the acquisition of information and skills related to: the function of the larynx, the disease, the objectives and consequences of surgery and treatments; the possibility of carrying out professional, leisure and sexual activities; the possibility of training the esophageal voice; altered body image; and the development of skills for self-care with the tracheostomy.
[E5] Tracheostomy care education and its effect on knowledge and burden of caregivers of elderly patients: a quasi-experimental study(¹⁴).	2019, Türkiye.	To investigate the effect of tracheostomy management training for caregivers of elderly patients on caregivers’ levels of burden and knowledge.	Quasi-experimental.	Training increased the caregiver’s level of knowledge and reduced the burden of care. Attitudes and skills to be acquired should be explained in a language understandable to patients and caregivers and taught by demonstration methods during the hospitalization period.
[E6] Developing the tracheostomy care anxiety relief through education and support (T-CARES) program(¹⁵).	2014, United States.	To describe the development and results of the T-CARES program, developed in response to the high readmission rates of head and neck cancer patients discharged with a tracheostomy.	Quasi-experimental.	The T-CARES program shows promise in reducing anxiety and increasing aspiration competence in home caregivers of a family member with a new tracheostomy.
[E7] Gaining experience over time: The family caregivers’ perception of patients with a tracheostomy in home care(¹⁶).	2021, Iran.	To explain the experiences of caregivers and family members of patients with tracheostomies about caring for the patient at home.	Qualitative, content analysis.	The categories of experiences identified in the study include: need for training; need to receive care support; care challenges; burden; experience, hope and inner satisfaction.
[E8] Is disinfection of mechanical ventilation tubing needed at home(¹⁷)?	2006, Belgium.	To determine the level of cleanliness and sterility of the home ventilation circuit (HVC) in patients on home ventilation and the efficiency of the recommended HVC cleaning protocol.	Experimental.	Recommendations such as using a dishwasher twice a month to wash all parts of the tubes, circuits and ventilation masks, and cleaning tracheostomy tubes with hydrogen peroxide or through a hot bath with a brush and detergent were presented. Decontamination is only indicated when the tube is visually dirty and/or when tracheostomized patients are susceptible to respiratory tract infections.
[E9] Caring for patients with a tracheostomy at home: a descriptive, cross-sectional study to evaluate health care practices and caregiver burden(¹⁸).	2019, Türkiye.	To determine the health care practices and burden of family caregivers of tracheostomy patients living at home.	Descriptive, cross-sectional.	The care behavior of caregivers was assessed in the following categories: knowledge of emergency care, number of instruments for care, frequency of home visits, experience in emergency situations in the last six months and the patient’s activities of daily living.
[E10] Home care nursing advice for patients with head and neck cancer in India(¹⁹).	2006, India.	Instructing patients, family members and caregivers on the procedures and care required for the mouth, tracheostomy and nasogastric tube.	Clinical opinion.	Tracheostomy care includes changing and cleaning the inner tube; cleaning around the tracheostomy site and changing dressings daily; looking for signs of infection in the mouth and stoma area; as well as preparing solutions to sanitize the structures involved in the device.
[E11] Long-term care of the patient with a tracheostomy(²⁰).	2005, United States.	To discuss the components of a long-term tracheostomy treatment program.	Clinical opinion.	Patient education should begin before tracheostomy insertion and include: basic airway anatomy; justification for tracheostomy use; description of tube operation; signs and symptoms of respiratory distress; suctioning technique; tube cleaning and maintenance; stoma site assessment and cleaning; cardiopulmonary resuscitation; emergency decannulation and reinsertion procedures; tube change procedure; use of equipment and supplies.
[E12] Tracheostomy selfcare: The Nottingham System(²¹).	1992, England.	To describe the Nottingham System, which aims to teach tracheostomy self-care in a step-by-step manner.	Descriptive.	Care is described as: recognizing the need to clean and change the tube; removing, cleaning and inserting the inner tube; preparing the equipment for changing the outer tube; applying tapes; removing, cleaning and inserting the outer tube; skin care.
[E13] Effect of videotape for home instruction on the quality of life of tracheostomy patients: a randomized clinical trial(²²).	2015, Iran.	Verifying the effect of instructional videos on the quality of life of people with tracheostomies.	Quasi-experimental.	The daily care presented was: bathing, shaving, suctioning, dressing the peristomal skin, cleaning the tracheostomy tube, knowing how to identify symptoms of infection at the tracheostomy site, knowing how to communicate with other people and how to present in public.
[E14] Helping a laryngectomy patient go home(²³).	1985, United States.	To describe care for laryngectomized patients, ranging from communication to teaching self-care.	Clinical opinion.	Care aimed at helping patients regain independence and autonomy was described, such as communication training, daily cannula removal and cleaning, nutritional counseling and other self-care procedures.

BHN	Tracheostomy care in the home environment
BHN	Care	Recommendations on how to carry out care
Psychobiologic	Aspiration of secretions(¹,¹¹,¹²,¹⁴,¹⁵,¹⁸,²⁰,²²,²³).	– Use aseptic technique(¹¹). – Pre-oxygenate the patient(¹⁸). – Use vacuum pressure between 100 and 150 mmHg(¹¹,¹²). – Perform the procedure within 10 to 15 seconds(¹¹,¹²,²³). – Instill saline solution(²³). – Use a portable aspirator(¹). – Perform the procedure daily, 1 to 5 times a day(¹⁸).
	Stoma care: cleaning and changing dressings(¹¹-¹⁶,¹⁸-²³).	– Change the dressing twice a day or as necessary given the amount of secretions(¹¹). – Change the dressing daily(¹²,¹⁹). – Sanitize the peristomal skin with saline solution(¹²,¹⁹). – Sanitize the peristomal skin with 3% hydrogen peroxide, soap and water, absorbent cotton, cotton buds, clean cloths and gauze(¹⁵,²⁰). – Identify signs of infection in the stoma(²²). – Use sterile water (obtained after boiling water for 20 minutes), a mirror to guide cleaning and gauze(²³).
	Hygienization of the endocannula(¹,¹¹-²³).	– Perform mechanical cleaning with sterile water or sterile saline solution(¹¹,²³). – Clean with hydrogen peroxide(¹⁷,²³). – Clean the endocannula daily(¹²,¹³,²³). – Use lukewarm water and neutral detergent (with the exception of silicone cannula, where only saline solution is recommended)(¹²). – Use brushes(¹,¹¹,¹²) or gauze(¹¹). – Use a dishwasher for 90 minutes at 70ºC or use hot water, brushes and detergent, followed by complete drying(¹⁷). – Clean with sodium bicarbonate solution, cloth or gauze and running water, boil the endocannula for 10 minutes and dry with a clean cloth after cooling(¹⁹).
	Tracheostomy fixation(¹¹,¹²,¹⁴,¹⁵,²¹).	– Change the fixation with four hands (two people)(¹¹). – Change the fixation every day, keeping a gap of two fingers so as not to suffocate the patient(¹²). – Change the fixation every day, keeping a gap of one finger between the fixator and the patient’s neck(¹⁵).
	Airway humidification(¹¹,¹²,¹⁴,¹⁸,²⁰).	– Perform airway nebulization daily, 1 to 5 times a day(¹⁸).
	Emergency care(¹²,¹⁵,¹⁶).	– Reinsert the cannula (in case of decannulation)(¹⁵). – Remove the endocannula (in the event of a mucous plug), assess breathing, aspirate secretions and, if the patient does not improve, call the emergency services(¹⁵). – Avoid removing the tracheostomy tube(¹⁶).
	Stoma protection(¹³).	– Protect the stoma with elements that prevent the entry of foreign bodies(¹³).
	Nutrition(¹⁴,¹⁸).	– Offering a balanced diet(¹⁸).
	Management of cuff(¹⁴,¹⁸).	No recommendations / adaptations.
	Hand hygiene before handling the tracheostomy(¹⁴,¹⁶).	No recommendations / adaptations.
Psychosocial	Re-establishing the ability to communicate(¹,¹³,¹⁴,¹⁸,²⁰,²²,²³).	– Instruct the patient about the esophageal voice(¹,¹³) and communication aids(¹).
Psychosocial	Social reintegration of the patient(¹,²²).	– Ensure family support by developing strategies(¹). – Encourage the occupation of spaces and the adoption of common routines(¹).

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