Securement of Tracheostomy Collar After Free Flap Surgery for Patients With Head And Neck Cancer

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BACKGROUND: For patients with head and neck cancer who have undergone microvascular free flap surgery, securing a tracheostomy collar onto the neck using the traditional method (ie, with tracheostomy ties) is contraindicated because the ties may compress the newly vascularized tissue. However, no clear guidance exists for the use of other methods in these patients. Current techniques often use safety pins, which can cause injury to staff members. OBJECTIVE: To identify 1 or more methods of securing a tracheostomy collar that would maximize patient mobility, minimize the risk of staff injury, and be easy to use. METHODS: This pilot study had a descriptive design, with data collected from staff members caring for patients with head and neck cancer after microvascular free flap surgery. Three models of tracheostomy securement were evaluated, with each used for 10 postoperative patients with head and neck cancer (n = 30). Staff members rated each model on a 4-point Likert scale. RESULTS: The overall median score of all models was 3.5. Model 2 (collar secured to tubular bandages using binder rings) was rated significantly higher than model 3 (collar secured to tubular bandages using tracheostomy ties) overall (P = .04) as well as for staying in place when the patient was mobile (P = .04) and for ease of changing out parts (P = .01). CONCLUSION: Several practical methods exist for securing a tracheostomy collar in patients with head and neck cancer who have undergone free flap surgery. These methods may be good alternatives to the use of safety pins.

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