TRACHEOSTOMY TRACHEOSTOMY

Sanjay Kumar KulchaniaSanjay Kumar Kulchania

(LECTURER) (LECTURER)

M.M.INSTITUTE OF M.M.INSTITUTE OF MEDICAL & NURSING MEDICAL & NURSING

SCIENCESSCIENCES

TracheotomyTracheotomy • operative procedure that operative procedure that

creates an artificial opening in creates an artificial opening in the trachea.the trachea.

TracheostomyTracheostomy • ccreation of permanent or semi reation of permanent or semi

permanent opening in trachea.permanent opening in trachea.

AnatomyAnatomy • Trachea lies in midline of the Trachea lies in midline of the

neck extending from cricoid neck extending from cricoid cartilage (C6) superiorly to the cartilage (C6) superiorly to the tracheal bifurcation at the level tracheal bifurcation at the level of sternal angle (T5).of sternal angle (T5).

• Comprises 16-20 C shaped Comprises 16-20 C shaped cartilage rings.cartilage rings.

• Length 10-12cm.Length 10-12cm.• Diameter 15-20mm.Diameter 15-20mm.

IndicationsIndications1.1. Upper Airway Obstruction.Upper Airway Obstruction.

2.2. Pulmonary Ventilation.Pulmonary Ventilation.

3. Pulmonary Toilet.3. Pulmonary Toilet.

4. Elective Procedure4. Elective Procedure

1.1. Upper Airway ObstructionUpper Airway Obstruction

a. Traumab. Foreign bodyc. Infectionsd. Malignant lesions

2.2. Pulmonary VentilationPulmonary Ventilation

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

3.3. Pulmonary ToiletPulmonary Toilet

• Those who cannot cough and clear their chest.

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

4.4. Elective ProceduresElective Procedures

• For major head and neck operations.

Elective TracheostomyElective TracheostomyAnaesthesiaAnaesthesia: G A: G A

Position:Position: Supine with sand bag Supine with sand bag under the shoulderunder the shoulder

IncisionIncision:horizontal incision b/w :horizontal incision b/w cricoid cartilage and suprasternal cricoid cartilage and suprasternal

notch.notch.

Division /retractionDivision /retraction of thyroid of thyroid isthmusisthmus

Opening of TracheaOpening of Trachea and insertion of and insertion of tubetube

• Emergency Emergency TracheostomyTracheostomy

Within 2-4 mints with vertical Within 2-4 mints with vertical incisionincision

• Cricothyrotomy/mini Cricothyrotomy/mini tracheostomytracheostomy

Transverse incision over the Transverse incision over the cricothyroid membrane. Keep cricothyroid membrane. Keep only for 3-5 daysonly for 3-5 days

Pediatric TracheostomPediatric Tracheostom

Vertical incision in trachea b/w 2Vertical incision in trachea b/w 2ndnd and 3 and 3rdrd ring.ring.

No excision of ant. Wall of tracheaNo excision of ant. Wall of tracheaSecure the tube with neck by two suturesSecure the tube with neck by two sutures

Percutaneus Dilational Percutaneus Dilational TracheostomyTracheostomy

ICU Bed SideTracheostomyICU Bed SideTracheostomyUse of guide wire and DilatorsUse of guide wire and DilatorsUnder the vision of Bronchoscope through Under the vision of Bronchoscope through

endotracheal tubeendotracheal tubeLess time ,Less ExpensiveLess time ,Less ExpensiveNot suitable for thick neck and in Not suitable for thick neck and in

emergencyemergency

Complications of TracheostomyComplications of Tracheostomy

Intraopertaive Complications.Intraopertaive Complications. Bleeding and injury to big vesselsBleeding and injury to big vessels Injury to tracheoesophageal wallInjury to tracheoesophageal wall PneumothorexPneumothorex

Early ComplicationsEarly Complications BleedingBleeding Tracheostomy tube obstructionTracheostomy tube obstruction Tracheostomy tube displacementTracheostomy tube displacement InfectionInfection

Late ComplicationsLate Complications Tracheal StenosisTracheal Stenosis Granulation tissueGranulation tissue Tracheocutaneus fistulaTracheocutaneus fistula Tracheo - inominate fistulaTracheo - inominate fistula

PROBLEMS DURING PROBLEMS DURING TRACHEOSTOMY CARE TRACHEOSTOMY CARE

1.1. Dislocation of tracheostomy Dislocation of tracheostomy tube.tube.

2.2. Bleeding from stoma or during Bleeding from stoma or during suction.suction.

3.3. Blockage of tracheostomy tube.Blockage of tracheostomy tube.

4.4. Aspiration and swallowing Aspiration and swallowing problems.problems.

5.5. Speaking problems.Speaking problems.

HOME CARE PLAN HOME CARE PLAN 1.1. Education and training of the Education and training of the

attendant.attendant.

2.2. Supply of dressing, suction Supply of dressing, suction catheters and suction machine.catheters and suction machine.

3.3. When to come to the hospital.When to come to the hospital.

4.4. Visit by community nurse.Visit by community nurse.