在放射科预防和处理与气管造口术相关的紧急情况：安全与准备的最佳实践
Preventing and Managing Tracheostomy-Related Emergencies in the Radiology Suite: Best Practices for Safety and Preparedness.
作者信息
Morris Linda L, Brenner Michael J, Williams Ricky L, Pandian Vinciya
机构信息
Clinical Research Scientist, Shirley Ryan AbilityLab, Professor, Physical Medicine and Rehabilitation, Anesthesiology, Northwestern University Feinberg School of Medicine.
Associate Professor, Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, United States, President, Global Tracheostomy Collaborative, Chicago, IL, United States.
出版信息
J Radiol Nurs. 2025 Jun;44(2):150-160. doi: 10.1016/j.jradnu.2025.03.004. Epub 2025 Jun 3.
BACKGROUND
Airway emergencies in patients with tracheostomies are life-threatening and may arise from tube dislodgment, obstruction, bleeding, or improper handling during patient transfers. While these incidents are rare in radiology suites, the limited experience of staff with tracheostomy care heightens the risk of adverse outcomes. Prompt and well-coordinated responses are essential to ensure patient survival.
OBJECTIVE
This review identifies risk factors for tracheostomy-related emergencies in radiology and offers evidence-based recommendations to improve patient safety, staff preparedness, and emergency response.
METHODS
A comprehensive review of peer-reviewed literature, malpractice claims, clinical guidelines, and expert consensus statements was conducted. Databases including PubMed, Nexis Uni, and legal case repositories were searched for studies, reports, and expert recommendations related to tracheostomy emergencies. Findings were synthesized on complications, risk factors, and prevention strategies.
RESULTS
Key risk factors for tracheostomy emergencies include improper tube securement prior to transfer, inadequate staff training, and failure to recognize and manage early signs of airway compromise. The first postoperative week following tracheostomy placement has elevated risk due to immaturity of the stoma. Evidence suggests that structured interventions, such as pre-procedure checklists, standardized emergency kits, and targeted staff education, significantly reduce the incidence of complications.
CONCLUSION
Implementing best practices, including pre-procedure preparedness and emergency management protocols, is crucial for minimizing tracheostomy-related complications in radiology settings. Increasing staff awareness and training on tracheostomy care and emergencies can improve patient outcomes and reduce the likelihood of litigation. To sustain competency and ensure rapid, effective responses to emergencies, institutions should implement consistent annual training programs focused on tracheostomy management. Regular simulation-based exercises and interdisciplinary training sessions can reinforce critical airway management skills, promote teamwork, and improve adherence to safety protocols. Future research should aim to assess the effectiveness of quality improvement initiatives in reducing tracheostomy-related adverse events.
背景
气管造口术患者的气道紧急情况危及生命，可能由气管导管移位、阻塞、出血或患者转运期间处理不当引起。虽然这些事件在放射科很少见，但工作人员气管造口护理经验有限会增加不良后果的风险。迅速且协调良好的应对措施对于确保患者存活至关重要。
目的
本综述确定放射科中与气管造口术相关紧急情况的风险因素，并提供基于证据的建议，以提高患者安全性、工作人员的准备情况和应急反应能力。
方法
对同行评审文献、医疗事故索赔、临床指南和专家共识声明进行了全面综述。检索了包括PubMed、Nexis Uni和法律案例库在内的数据库，以查找与气管造口术紧急情况相关的研究、报告和专家建议。对并发症、风险因素和预防策略的研究结果进行了综合分析。
结果
气管造口术紧急情况的关键风险因素包括转运前气管导管固定不当、工作人员培训不足以及未能识别和处理气道受损的早期迹象。气管造口术后的第一周由于造口不成熟，风险升高。有证据表明，结构化干预措施，如术前检查表、标准化应急包和针对性的工作人员教育，可显著降低并发症的发生率。
结论
实施最佳实践，包括术前准备和应急管理方案，对于将放射科环境中与气管造口术相关的并发症降至最低至关重要。提高工作人员对气管造口护理和紧急情况的认识及培训，可改善患者预后并降低诉讼可能性。为保持能力并确保对紧急情况做出迅速、有效的反应，机构应实施侧重于气管造口术管理的年度一致培训计划。定期进行基于模拟的演练和跨学科培训课程可强化关键气道管理技能、促进团队合作并提高对安全协议的遵守情况。未来的研究应旨在评估质量改进举措在减少与气管造口术相关不良事件方面的有效性。
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