TRACHEOSTOMY
DR. A. NAVEED
FRCS (Ed)ENT Department
Tawam Hospital
Al-Ain, Abu Dhabi
U.A.E.
Tracheotomy
•operative procedure that createsan artificial opening in thetrachea.
Tracheostomy
•creation of permanent or semipermanent opening in trachea.
Anatomy
•Trachea lies in midline of the neckextending from cricoid cartilage(C6) superiorly to the trachealbifurcation at the level of sternalangle (T5).
•Comprises 16-20 C shaped cartilagerings.
•Length 10-12cm.
•Diameter 15-20mm.
Indications
1.Upper Airway Obstruction.
2.Pulmonary Ventilation.
3. Pulmonary Toilet.
4. Elective Procedure
1.Upper Airway Obstruction
a.Trauma
b.Foreign body
c.Infections
d.Malignant lesions
2.Pulmonary Ventilation
•Tracheostomy should beperformed in a patient stillrequiring ventilation throughan endotracheal tube formore than a one week.
3.Pulmonary Toilet
•Those who cannot cough andclear their chest.
•Prevent aspiration by lowpressure high volume cufftracheostomy tube.
4.Elective Procedures
•For major head and neckoperations.
Elective Tracheostomy
Anaesthesia: G A
Position: Supine with sand bag under theshoulder
Incision:horizontal incision b/w cricoidcartilage 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/minitracheostomy
Transverse incision over thecricothyroid membrane. Keep onlyfor 3-5 days
Pediatric Tracheostom
•Vertical incision in trachea b/w 2nd and 3rdring.
•No excision of ant. Wall of trachea
•Secure the tube with neck by two sutures
Percutaneus DilationalTracheostomy
•ICU Bed SideTracheostomy
•Use of guide wire and Dilators
•Under the vision of Bronchoscope throughendotracheal 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 TRACHEOSTOMYCARE
1.Dislocation of tracheostomy tube.
2.Bleeding from stoma or duringsuction.
3.Blockage of tracheostomy tube.
4.Aspiration and swallowing problems.
5.Speaking problems.
HOME CARE PLAN
1.Education and training of theattendant.
2.Supply of dressing, suction cathetersand suction machine.
3.When to come to the hospital.
4.Visit by community nurse.
