Download - Tracheostomy
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TRACHEOSTOMY
DR. A. NAVEEDFRCS (Ed)
ENT DepartmentTawam Hospital
Al-Ain, Abu DhabiU.A.E.
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Tracheotomy •operative procedure that
creates an artificial opening in the trachea.
Tracheostomy •creation of permanent or
semi permanent opening in trachea.
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Anatomy •Trachea lies in midline of the
neck extending from cricoid cartilage (C6) superiorly to the
tracheal bifurcation at the level of sternal angle (T5).
•Comprises 16-20 C shaped cartilage rings.
•Length 10-12cm.•Diameter 15-20mm.
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Indications.1Upper Airway Obstruction.
.2Pulmonary Ventilation.
3 .Pulmonary Toilet.
4 .Elective Procedure
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.1Upper Airway Obstruction
a. Traumab. Foreign bodyc. Infectionsd. Malignant lesions
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.2Pulmonary Ventilation
• Tracheostomy should be performed in a patient still requiring ventilation through an endotracheal tube for more than a one week.
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.3Pulmonary Toilet
• Those who cannot cough and clear their chest.
• Prevent aspiration by low pressure high volume cuff tracheostomy tube.
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.4Elective Procedures
• For major head and neck operations.
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Elective Tracheostomy
Anaesthesia: G APosition: Supine with sand bag
under the shoulderIncision:horizontal incision b/w
cricoid cartilage and suprasternal notch.
Division /retraction of thyroid isthmus
Opening of Trachea and insertion of tube
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•Emergency Tracheostomy
Within 2-4 mints with vertical incision
•Cricothyrotomy/mini tracheostomy
Transverse incision over the cricothyroid membrane. Keep
only for 3-5 days
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Pediatric Tracheostom
•Vertical incision in trachea b/w 2nd and 3rd ring.
•No excision of ant. Wall of trachea
•Secure the tube with neck by two sutures
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Percutaneus Dilational Tracheostomy
•ICU Bed SideTracheostomy•Use of guide wire and Dilators•Under the vision of Bronchoscope through
endotracheal tube•Less time ,Less Expensive•Not suitable for thick neck and in emergency
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Complications of Tracheostomy
•Intraopertaive Complications.•Bleeding and injury to big vessels•Injury to tracheoesophageal wall•Pneumothorex
•Early Complications•Bleeding•Tracheostomy tube obstruction•Tracheostomy tube displacement•Infection
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•Late Complications•Tracheal Stenosis•Granulation tissue•Tracheocutaneus fistula•Tracheo - inominate fistula
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PROBLEMS DURING TRACHEOSTOMY CARE
.1Dislocation of tracheostomy tube..2Bleeding from stoma or during
suction..3Blockage of tracheostomy tube.
.4Aspiration and swallowing problems.
.5Speaking problems.
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HOME CARE PLAN
.1Education and training of the attendant.
.2Supply of dressing, suction catheters and suction machine.
.3When to come to the hospital..4Visit by community nurse.