Chapter 27: Living with and beyond cancer
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Legal and professional issues
One of the care requirements is placing an HME device. This is an advanced practice role of a specialist nurse who has met the required competencies (see Table 27.23).
Procedure guideline 27.23
HME placement
Table 27.22 Prevention and resolution (Procedure guideline 27.23)
| Problem | Cause | Prevention | Action |
|---|---|---|---|
| Skin reaction. | HME baseplate causing skin to react. | Regular use of barrier skin preparation. | Remove baseplate and allow skin to recover. |
| Ongoing skin reaction. | HME baseplate causing skin to react. | Trial of different baseplates. | Remove baseplate, allow skin to recover and trial a different baseplate. |
| Stomal shrinkage. | Post‐operative complication. | Daily measuring of stoma size. | Consider insertion of a laryngeal tube. |
Table 27.23 Competencies for use of an HME device in a laryngectomy patient
| Knowledge and understanding | Skills |
|---|---|
| Altered anatomy following a laryngectomy | An ability to recognize a laryngectomy versus a tracheostomy |
| The function of the HME | Ability to recognize an HME |
| The importance of placing an HME on a patient | An ability to provide the patient/carer with the relevant physical preparation for attaching the HME |
| Principles of HME selection | An ability to match the correct HME type to the patient |
| Complications that may arise post HME placement such as skin reaction, stomal discomfort | An ability to evaluate the HME and recognize patient discomfort |
