Introduction

Pressure wounds are a known and well-documented complication of pediatric tracheostomy. They represent a serious patient safety concern. Despite the frequency of pediatric tracheostomies at this institution, there is no standardized post-operative protocol for pediatric tracheostomy patients. Removing the variability in post-operative practices should lead to more consistent patient outcomes and decrease preventable complications. We sought to identify the best practices to establish a cohesive post-operative tracheostomy protocol for pediatric patients that effectively reduces the risk of tracheostomy pressure wounds and improves patient safety.

Methods

Authors performed a retrospective chart review on all pediatric tracheostomy patients at this institution between March 2024 and January 2025 to identify documented tracheostomy pressure injuries. Additional pertinent variables collected included patient age, patient weight, type of tracheostomy tie used, if the tracheostomy was sutured, the type of stomal suture used, the presence and placement of a trach dressing in the immediate post-operative period. Statistical analysis was then performed to identify variables associated with the development of a pressure wound. To ensure practical applicability of the proposed interventions, identify best practices, and assess barriers to implementation in the clinic space, discussions were held with the pediatric tracheostomy nursing team.

Results

34 pediatric tracheostomies were performed during the study period. Of these, 11 patients (32%) developed tracheostomy pressure wounds. Following statistical analysis, no clear “bright spots” appeared, and no variables were statistically significant. However, trends suggested that younger patients and patients without a trach dressing appeared to be more likely to develop a pressure injury. There were no accidental decannulations during the study period.

Conclusions 

Based on our findings and discussions with the pediatric tracheostomy nursing team, we developed a standard practice intervention bundle focusing on surgical technique, dressing placement and changes, method of trach securement, and post-operative positioning. Further data collection following implementation will be necessary to assess the effectiveness of the protocol and guide future revisions to promote safer and more consistent post-operative care for our patients.