Registered nurses' knowledge about and recognition of displaced tracheotomy tubes in patients with unobstructed upper airways

An internet-based study was conducted to evaluate registered nurses' knowledge and recognition of assessment parameters for displaced tracheostomy tubes in patients with unobstructed upper airways. Furthermore, the study sought to determine whether there were any factors that were predictors of nurses' knowledge levels. There were 221 nurses who participated in the study that queried their knowledge related to recognition and intervention for patients with displaced tracheostomy tubes in obstructed and unobstructed upper airways. A questionnaire was used to assess knowledge.;The study results indicated that educational level is independent of nurses' knowledge of tracheotomy management for a displaced tracheotomy tube in tracheotomy patients with an unobstructed (chi2 (6, N =186) = 2.692, p > .05) or obstructed ( p > .05) upper airway. Nurses' educational level did not influence whether they had sufficient knowledge of tracheotomy management to adequately care for patients with displaced tracheotomy tubes and obstructed upper airways; in one example, nurses selected an action that would be appropriate for emergency management of the tracheotomy patient with an unobstructed upper airway, but more than 25% of the nurses selected this same action again for the same scenario with a patient with an obstructed upper airway, which would cause death in the patient. A significant knowledge gap was noted related to identification and appropriate management of displaced tracheotomy tubes or accidental decannulation in patients with unobstructed and obstructed upper airways. Eighty-three percent of nurses did not recognize that, in the patient with an unobstructed upper airway, improved voice signals a need to assess for tracheotomy tube displacement.;The study also found that, in term of practice settings, nurses who were employed in an inpatient practice were a significant predictor for higher scores for knowledge of unobstructed airway when compared to nurses who practiced in other practice settings (B = -.693, p = .016). On the parameters of practice setting for overall knowledge of obstructed and unobstructed airways, nurses who practiced in an inpatient setting was a significant predictor of overall knowledge scores when compared to nurses who practiced in a nursing home setting (B = -0.161, p = .044). Experience providing care to tracheotomy patients was the strongest predictor of overall knowledge scores (B = 0.181, p = .017).;Failure to, in a timely fashion, detect a tracheotomy tube displacement into the subcutaneous tissues of a patient who has a tracheotomy inserted as a protective measure in anticipation of a future upper airway obstruction and intervene may result in increased patient morbidity and mortality. Further, failure of the nurse to recognize that there is a difference in how to provide respiratory support and patient management for an accidental decannulation in a tracheotomy patient with an unobstructed versus an obstructed airway may lead to patient death due to improper action on the part of the nurse. In addition, the nursing literature may inadvertently inform nurses to perform actions that may lead to patient death because many articles fail to clearly distinguish between assisting ventilation in the tracheotomy patient with an unobstructed airway and appropriate options for the patient with an obstructed upper airway.