November 2021 – Repertoire Magazine
By Susan Gallagher, PhD, RN
Prevention of device-related skin injury is a top concern of healthcare professionals and the facilities where they provide care. This is particularly true when caring for plus size individuals.
The Dale Tracheostomy Tube Holder supports bariatric care in two ways. Patients who have a high degree of adiposity between the skin surface and the tracheal area require a deep surgical incision to locate the trachea. The Dale Tracheotomy Tube Holder is designed to provide secure positioning and minimize movement of the tracheostomy tube. This is an important factor in the presence of a deep surgical incision because unnecessary movement of the tracheostomy tube can result in not only trauma to the tracheostomy wound, but also accidental dislodgement or displacement of the tube, tracheal fistula, tracheal stenosis, or airway granuloma.
The Dale Tracheostomy Tube Holder is also instrumental in preventing device-related injury that occurs when gauze or twill tracheostomy tube ties burrow into the soft tissue around the neck, especially in the presence of deep skin folds. The exclusive moisture-wicking neck band lining serves to reduce the risk of skin injury due to moisture associated skin damage (MASD) within deep skin folds.
Understanding the relationship between the skin, obesity and respiratory issues has become a principal concern in the presence of the COVID-19 pandemic, and a lesson learned. Researchers have learned that morbid obesity is an independent risk factor for severe COVID-19 infection.
The Centers for Disease Control (CDC) reported that individuals who have obesity are at an increased risk of severe illness from COVID-19, and may have triple the rate of hospitalization due to the infection. For instance, a study of COVID-19 cases suggested that risks of hospitalization, intensive care unit admission, invasive mechanical ventilation, and death were higher with increasing BMI. Simmonet and others reported that 30% of adult COVID-19 hospitalizations that occurred in the United States between the beginning of the pandemic and November 18, 2020 were attributed to obesity. From a respiratory perspective, obesity decreases lung capacity and reserve and can make ventilation more difficult. The increased risk for hospitalization or death was particularly pronounced in those under age 65. To that end, a keen understanding of respiratory care is essential when caring for the plus sized patient anytime, but especially in the presence of the current pandemic.
The issues associated with improperly securing a tracheostomy tube can lead to a device-related skin injury, dislodgment of the tube and more. Each of these may lead to adverse clinical, economic and humanistic outcomes for the patient.
Demeulemeester, F., de Punder, K., van Heijningen, M., & van Doesburg, F. (2021). Obesity as a Risk Factor for Severe COVID-19 and Complications: A Review. Cells, 10(4), 933. https://doi.org/10.3390/cells10040933
Kompaniyets L, Goodman AB, Belay B, et al. Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020. (2021). MMWR Morb Mortal Wkly Rep 2021;70:355–361. DOI: http://dx.doi.org/10.15585/mmwr.mm7010e4.
O’Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. (2021). Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis. Journal of the American Heart Association. 2021 Feb;10(5):e019259. doi:10.1161/JAHA.120.019259.
Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, Labreuche J, Mathieu D, Pattou F, Jourdain M; LICORN and the Lille COVID-19 and Obesity study group. High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Requiring Invasive Mechanical Ventilation. Obesity (Silver Spring). 2020 Jul;28(7):1195-1199. doi: 10.1002/oby.22831.
The Joint Commission. (2017). Quick Safety #43: Managing Medical Device Related Pressure Injuries. Accessed at: https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-43-managing-medical-devicerelated-pressure-injuries