Übersichtsarbeit


Haut- und Schleimhautpflege nach Tracheotomie: Ein Update für die Intensivpflege

Skin and mucosal care after tracheotomy: an update for intensive care

Keywords | Summary | Correspondence | Literature

Keywords

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Schlüsselworte

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Summary

Tracheostomies are common procedures in critical care with an increasing trend worldwide due to COVID-19 pandemic. Benefits of tracheostomy are contrasted by complications such as the risk of wound infection. This article describes how to provide skin and mucosal care after tracheostomy in the intensive care unit and strategies for preventing later complications. Qualified tracheostomy care starting immediately after surgery is an important factor in avoiding later complications. To ensure the function and to prevent complications the use of a standard of care algorithm is recommendable. Daily skin and wound care and regular changes of tracheostomy tubes are basics to prevent complications. Very important is the early recognition of complications at the stoma with transition into the stoma and upper trachea for prevention and early detection of tracheal stenosis as an interdisciplinary responsibility. The essential in prevention and treatment of pressure sores is off-loading. Assistance in stoma care with illustrated nursing guides is recommended to standardize the language used to describe the various tracheostomy skin inspection abnormalities.

Zusammenfassung

Tracheostomien sind häufige Eingriffe in der Notfallmedizin mit einem weltweit ansteigenden Trend durch die COVID-19-Pandemie. Die Vorteile der Tracheostomie werden durch Komplikationen wie dem Risiko der Wundinfektion relativiert. In dieser Übersicht werden Haut- und Schleimhautpflege nach Tracheostomie und Strategien zur Vermeidung späterer Komplikationen aufgezeigt. Ein qualifiziertes Tracheostomie-Management beginnend unmittelbar nach dem chirurgischen Eingriff ist ein entscheidender Faktor zur Vermeidung späterer Komplikationen. Hierzu ist die Einführung von Algorithmen einer standardisierten Pflege empfehlenswert. Tägliche Haut- und Schleimhautpflege und regelmäßiger Wechsel der Tracheostoma-Tuben sind die Grundlagen zur Komplikationsprävention. Von herausragender Bedeutung ist die frühzeitige Erkennung von Komplikationen am Stoma mit Übergang in das Stoma-Innere und die oberen Tracheal-Abschnitte bei der Vermeidung und Diagnostik einer drohenden Trachealstenose als interdisziplinäre Aufgabe. Ganz entscheidend ist hierbei die Druckentlastung (off-loading). Illustrierte Pflegeanleitungen ermöglichen die standardisierte Erfassung der Befunde in einer vereinheitlichten Nomenklatur.

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Korrespondenz-Adresse

Dr.med. Andreas Nowak
Klinik für Anästhesiologie und Intensivmedizin,
Notfallmedizin & Schmerztherapie, Städtisches
Krankenhaus Dresden -
Akademisches Lehrkrankenhaus
Friedrichstr. 41
DE-01067 Dresden
E-mail: andreas.nowak@klinikum-dresden.de
https://orcid.org/0000-0003-4105-4358

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