The lecture of Assistant Professor Ann Kakabadze

Tracheostomy

Tracheostomy - is a surgical procedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea (windpipe)

Indications:

•Airway obstruction Facial trauma Head and neck cancers Angioedema Laryngeal dysfunction Foreign body Inflammatory conditions, neoplasms, Obstructive sleep apnea

• The patient may be in a coma, or need a ventilator to pump air into the lungs for a long period of time

• Pulmonary Ventilation

• Pulmonary Toilet

Tracheostomy Tubes

A commonly used tracheostomy tube consists of three parts: outer cannula with flange (neck plate), inner cannula, and an obturator The outer cannula is the outer tube that holds the tracheostomy open. A neck plate extends from the sides of the outer tube and has holes to attach cloth ties or velcro strap around the neck. The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning. The obturator is used to insert a tracheostomy tube. It fits inside the tube to provide a smooth surface that guides the tracheostomy tube when it is being inserted

Emergency tracheotomy:

when a person with a throat obstruction is not able to breathe at all-no gasping sounds, no coughing-and only after you have attempted to perform the Heimlich maneuver three times without dislodging the obstruction

What you will need

•A first aid kit, if available

•A razor blade or very sharp knife

•A straw (two would be better) or a ballpoint pen with the inside (ink-filled tube) removed. If neither a straw nor a pen is available, use stiff paper or cardboard rolled into a tube. Good first aid kits may contain "trache" tubes

Find the indentation between the Adam's apple and the Cricoid cartilage.

Make a half-inch horizontal incision about one half inch deep.

Pinch the incision or insert your finger inside the slit to open it

Insert your tube into the incision, roughly one-half to one inch deep

Nonemergency tracheotomy:

Upper Tracheostomy

Middle Tracheostomy

Inferior Tracheostomy

Types of tracheostomy:

1- Upper tracheostomy;In the 1st and 2nd tracheal rings abovethe isthmus of the thyroid gland

2- Middle tracheostorny;In the 3rd and 4th trachea rings behindthe isthmus (operation of choice).

3- Inferior tracheostomyin the 5th and 6th rings below theisthmus.

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Procedures of the operation:Tracheostomy

1- Anaesthesia:a) No anaesthesia in cyanosed patients and urgent cases.b) Local: Infiltration with 1% Novocain.c) General: When there is no emergency (pre-operarive). 2- Position:Neck is extended and a sandbag is put under the shoulders

3- Incision:a) Midline incision from the lower border ofthe thyroid to the manubrium sterni

b) Cut the skin, superficial fascia, platysmaand the deep fascia connecting thepretracheal muscles (sternohyoid andsternothyroid) of the two sides.

c) Separate the pretracheal muscles of bothsides by a retractor .

Tracheostomy

Procedures of the operation:

4- The thyroid isthmus is divided between 2 kochers, transfixed by catgut to prevent bleeding and leak of thyroxin and then retracted.

5- Expose the trachea and inject 1/2 c.c surface anaesthetic (pantrocaine 1%) in the trachea to diminish the cough reflex

Tracheostomy

Procedures of the operation:

6- Fix the trachea and elevate it by a cricoid hook.7- Open the trachea by an incision or by removal of a circular part of the 3rd and 4th rings.8- Insert a suitable tracheostomy tube9- Close the wound after ligating the bleeding vessels

Tracheostomy

Procedures of the operation:

Compliation of tracheostomy tube

Proper sizein position

Long tube causingInjury ofesophagus

Long curvecausinginjury of bothoesophagus& trachea.

Small tube causingslipping out & surgicalemphysemaof neck.

Intraopertaive Early Late

•Bleeding and injury to big vessels•Injury to tracheoesophageal wall•Pneumothorex

•Bleeding•Tracheostomy tube obstruction•Tracheostomy tube displacement•Infection

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

Complications of Tracheostomy

The risks associated with tracheotomies are higher in the following groups of patients

Children, especially newborns and infants Smokers Alcoholics Obese adults Persons over 60 Persons with chronic diseases or

respiratory infections Persons taking muscle relaxants ,

sleeping medications, tranquilizers, or cortisone

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Aftercare

Postoperative care

A chest x ray is often taken

prescribe antibiotics to reduce the risk of infection

Home care

patient and his or her family members will learn how clearing it

Warm compresses can be used to relieve pain at the incision site

The patient is advised to keep the area dry

It is recommended that the patient wear a loose scarf over the opening when going outside