TRACHEOSTOMY

1
TRACHEOSTOMY

• DR. A. NAVEED
• FRCS (Ed) ENT Department
• Tawam Hospital
• Al-Ain, Abu Dhabi
• U.A.E.

2

• Tracheotomy
• operative procedure that creates an artificial
  opening in the trachea.
• Tracheostomy
• creation of permanent or semi permanent opening
  in trachea.

3

• 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.

4
(No Transcript)
5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8

• Indications
• Upper Airway Obstruction.
• Pulmonary Ventilation.
• 3. Pulmonary Toilet.
• 4. Elective Procedure

9

• Upper Airway Obstruction

• Trauma
• Foreign body
• Infections
• Malignant lesions

10

• Pulmonary Ventilation

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

11

• Pulmonary Toilet

• Those who cannot cough and clear their chest.
• Prevent aspiration by low pressure high volume
  cuff tracheostomy tube.

12

• Elective Procedures

• For major head and neck operations.

13
Elective Tracheostomy

• Anaesthesia G A
• Position Supine with sand bag under the shoulder
• Incisionhorizontal incision b/w cricoid
  cartilage and suprasternal notch.
• Division /retraction of thyroid isthmus
• Opening of Trachea and insertion of tube

14

• Emergency Tracheostomy
• Within 2-4 mints with vertical incision
• Cricothyrotomy/mini tracheostomy
• Transverse incision over the
  cricothyroid membrane. Keep only for 3-5 days

15
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

16
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

17
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

18

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

19
PROBLEMS DURING TRACHEOSTOMY CARE

• Dislocation of tracheostomy tube.
• Bleeding from stoma or during suction.
• Blockage of tracheostomy tube.
• Aspiration and swallowing problems.
• Speaking problems.

20
HOME CARE PLAN

• Education and training of the attendant.
• Supply of dressing, suction catheters and suction
  machine.
• When to come to the hospital.
• Visit by community nurse.