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Tracheotomy stoma care with betadine Tracheostomal care with povidone iodine Tracheostomy stomal care

last modified on: Fri, 06/12/2020 - 04:39

Tracheotomy stoma care   Tracheostomal care  Tracheostomy stomal care
Dilute betadine (povidone-iodine) applied to tracheostomal drain sponge

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Trachestomal care:       Dilute betadine solution (1:20 dilution in saline of 10% solution) applied to a drain sponge placed under the flanges of the tracheotomy tube for 10 minutes once - to - several times per day is then followed by placement of dry drain sponge.

Date:      __________________________

From: Dr. Henry Hoffman

University of Iowa Hospitals & Clinics

Iowa City, IA   52242

Ph:  319-356-2169

FAX:   319-356-3574

           

Name: ___________________________

Hospital #:  _______________________

B-day:   ____________________ 
Regarding:  Instructions for Betadine Soaked Dressing to Stoma

           

Supplies:

  • Drainage sponges
  • Dilute betadine solution
  • Dilute Betadine Solution:
    • Betadine Solution (10% Povidone-iodine)
    • 0.9% Normal Saline
    • Mix betadine and saline together  - make new batch every day
      • ~40cc normal saline
      • ~2-3cc betadine

Instructions:

Soak the T-cross area of the drainage sponge with ~5cc dilute betadine solution. Don’t soak the whole sponge.  Use both sponges in the package to ensure the betadine is actually touching the skin at the trach site.

Leave betadine sponge in place for ~10 minutes.  Then remove and place a clean dry drainage sponge. 

Apply betadine sponge 2 times per day

Replace clean/dry drainage sponge as needed to keep tracheostomy site/skin dry

Discussion:

Use of topical preparation with betadine solution has been found useful in decreasing infection associated with C-section (Yildirim 2012) and is also widely used in opthalmic surgery - with recent reports suggesting benefit to 1.25% povidine-iodine solution with the addition of topical levofloxacin (Ikuno 2012).  A 0.035% povidone-iodine preparation (1:20 dilution of 7% preparation (popiyodon gargle R povidone-iodine (PVP-I) was found to be an effective bactericidal mouth was by Oyanagi in 2012. 

Four reported cases (ref: Chepla 2012) of interstitial pneumonitis have been reported from betadine aspiration -- including documented aspiration of an estimated 2 cc of 10% solution in a 7 year old patient. Chepla and Gosain conclude that the report of this "very rare complication" following use of this very effective antimicrobial should not preclude its appropriate use, but should modify its use to decrease exposure of the tracheobronchial tree.   Our approach to the use of dilute betadine applied to a drain sponge is to apply an approximately 1:20 dilution of a 10% betadine solution (0.5%) to make it look like 'very dilute tea' for a 10 minute application to the moistened drain sponge before removal and replacment with a dry sponge.

We have had notable success in diminishing granulation tissue about tracheostomes with this technique and no observed pulmonary complications.

A prospective randomized study comparing 10% povidone-iodine with chlorhexidine-alcohol skin prep showed a 40% higher surgical infection rate with the iodine preparation than the alcohol based preparation (Darouiche et al 2010). The authors conclude that the superior clinical protection provided by chlorhexidine--alcohol is probably related to its more rapid action, persistent activity despite exposure to bodily fluids, and residual effect. The potential toxicity of chlorhexidine-alcohol compared to dilute (0.05% betadine solution) has prevented us from adopting its use in our tracheostomal care.

References:
Motta GJ, Trigilia D. : Ostomy Wound Manage. 2005 Jan;51(1):60-2, 64-6. The effect of an antimicrobial drain sponge dressing on specific bacterial isolates at tracheostomy sites.
Lusuardi M: Lower respiratory tract infections in chronic obstructive pulmonary disease outpatients with tracheostomy and persistent colonization by P. Aeruginosa. Respiratory Medicine 2003; vol 97: issue 11 pp 1205-1210
Motta GJ, Milen CT and Corbett LQ: Impact of antimicrobial gauze on bacterial colonies in wounds that require packing. Ostomy Wound Manage. 2004 Aug; 50(8):48-62
Chepla, K and Gosain AK: Interstitial pneumonitis after betadine aspiration. The Journal of craniofacial surgery 2012 vol:23 iss:6 pp 1787-1789
Yildirim G, Gunguorduk K, Asicioglu O, Basaran T, Temizkan O, Davas I, and Gulkilik A: Does vaginal preparation with povidone-iodine prior to caesarean delivery reduce the risk of endometitis? A randomized controlled trial. J Matern Fetal Neonatal Med 2012 Nov;25(11):2316-21
Ikuno Y, Sawa M, Tasujikawa M, Gomi F, Maeda N, and Nishida K: Effectiveness of 1.25% povidone-iodine combined with topical levofloxacin against conjunctiveal flora in intravitreal injection. Jpn J Ophtalmol. 2012 Sep; 56(5):497-501
Oyanagi,T: Potentials of mouthwashes in disinfecting cariogenic bacteria and biofilms leading to inhibition of caries. Open Dentistry Journal 2012 vol:6 pp 23-30
Darouiche RO, Wall MJ, Jr, Itani KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362:8--26

Ichibangase T, Yamano T, Miyagi M, Nakagawa T, Morizono T. Ototoxicity of Povidone-Iodine applied to the middle ear cavity of guinea pigs. Int J Pediatr Otorhinolaryngol. 2011;75(9):1078-1081.