A hydroconductive dressing to prevent tracheostomy-related pressure injuries

Moisture is one of many factors that place a patient at risk for pressure injury development. Four sutures hold tracheostomy devices tight over the clavicle. Post-operative swelling, drainage and secretions contribute to the development of pressure injuries under the faceplate. We were noticing pressure injuries developing under our tracheostomy faceplate soon after tracheostomy surgery.Routine tracheostomy care in our facility prior to our new interventions involved non-woven drain sponges and hydrophilic foam dressings around the tracheostomy and over the faceplate. The sponges were changed 2-6 times per day. The skin could only be better assessed under the faceplate 7-10 days post-operatively when sutures were removed. A case series of 15 patients with new tracheostomies are presented who were managed with a hydroconductive dressing. These were adult patients with varying diagnoses and lengths of stay. The hydroconductive dressing was applied intraoperatively. Through close monitoring, a protocol was devised to help nurses and respiratory therapists best manage the tracheostomy using the hydroconductive dressing.Prior to using the hydroconductive dressing, the new tracheostomy sites were moist with bloody drainage and thick secretions. Frequent dressing changes were required to prevent development of wounds and pressure injuries under the tracheostomy faceplate. During the evaluation, one developed a stage 2 pressure injury and the other had developed a stage 3 pressure injury. The stage 2 pressure injury healed within 5 days after placement of a hydroconductive dressing. The stage 3 pressure injury almost healed but was lost to follow-up due to discharge from our facility. All other patients who received a hydroconductive dressing had skin around their tracheostomy that were always dry and free of any signs of pressure.The hydroconductive dressing used in the evaluation proved to be an effective method of managing conditions that contributed to pressure injury development. The protocol for dressing changes decreased to 1-3 days per week.