TRACHEOSTOMY

DR. A. NAVEEDFRCS (Ed)

ENT DepartmentTawam Hospital

Al-Ain, Abu DhabiU.A.E.

Tracheotomy •operative procedure that

creates an artificial opening in the trachea.

Tracheostomy •creation of permanent or

semi permanent opening in trachea.

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.

Indications.1Upper Airway Obstruction.

.2Pulmonary Ventilation.

3 .Pulmonary Toilet.

4 .Elective Procedure

.1Upper Airway Obstruction

a. Traumab. Foreign bodyc. Infectionsd. Malignant lesions

.2Pulmonary Ventilation

• Tracheostomy should be performed in a patient still requiring ventilation through an endotracheal tube for more than a one week.

.3Pulmonary Toilet

• Those who cannot cough and clear their chest.

• Prevent aspiration by low pressure high volume cuff tracheostomy tube.

.4Elective Procedures

• For major head and neck operations.

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

•Emergency Tracheostomy

Within 2-4 mints with vertical incision

•Cricothyrotomy/mini tracheostomy

Transverse incision over the cricothyroid membrane. Keep

only for 3-5 days

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

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

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

•Late Complications•Tracheal Stenosis•Granulation tissue•Tracheocutaneus fistula•Tracheo - inominate fistula

PROBLEMS DURING TRACHEOSTOMY CARE

.1Dislocation of tracheostomy tube..2Bleeding from stoma or during

suction..3Blockage of tracheostomy tube.

.4Aspiration and swallowing problems.

.5Speaking problems.

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.