Material Sustainability and Patient’s Experiences of Silver Tracheostomy Tubes-An In-Vitro and In-Vivo Case Study

Abstract

Introduction: Tracheostomy tubes are used for enabling a free airway for patients with respiratory failures. In trachea, tracheostomy tubes are exposed to the alkaline tracheal secretion and lining fluid containing proteins, enzymes, organic acids, inorganic salts, and bacteria. Research shows severe material degradation of tracheostomy tubes made of polymeric materials after patient use. Silver tracheostomy tubes are made for long-term exposure up to several years.

The objectives were a) To evaluate and describe the performance and durability of sterling silver tracheostomy tubes, b) To preliminarily describe and discuss the resulting morphological changes of the material surface after 6 months of clinical use c) To describe the patient’s own experiences of having a silver tracheostomy tube for a prolonged period of time and d) To study the release rate of metal ions into synthetic biological fluids in-vitro.

Methods: Two different brands of silver tracheostomy tubes were studied in-vitro in synthetic body fluids. Six patients with silver tracheostomy tubes were included for long-term study of 6 months. Scanning Electron Microscopy was used to evaluate surface changes on the tube material. Patient’ s experiences were measured with a study specific questionnaire with open ended questions.

Results: There were initial irregularities and defects on the reference silver tubes. A significant difference in material degradation between the tube brands were found after patient use. The release rate of metal ions into synthetic biological fluids revealed higher concentrations of copper ions than of silver ions. Patient´s own experiences revealed the importance of having a properly fitted tube to avoid complications.

Conclusion: There was severe degradation on all tubes and significant differences between the tube brands. Patients found it important with a properly fitted tube which could make it possible for them to live a good life despite the chronic tracheostomy.

Keywords: Respiratory Care; Tracheostomy Tube; Silver; Material Degradation; Patient Experience; Chronic Tracheostomy

Abbreviations: PVC: polyvinylchloride; PU: polyurethane; NRC: National Respiratory Centre; SEM: Scanning electron microscopy; EDX: Energy- Dispersive X-Ray Spectroscopy; SBF: Simulated Biological Fluids; ALF: Artificial Lysosomal Fluid; ALF: Artificial Lysosomal Fluid; FAAS: Flame Atomic Absorption Spectroscopy; OSHA: Occupational Safety and Health Administration