?????????????? Tracheostomy

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?????????????? Tracheostomy

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Tracheostomy patients care

• Pre-operative assurance
• Intra-operative period
• Post-operative tracheostomy care
• Long-term tracheostomy care

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Pre-operative assurance

• Indications
• Advantages over endotracheal tube
• Post-tracheostomy status
• speaking
• eating
• Complications

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Intra-operative period

• Immediate complications
• Patients position
• Skin incision - Tracheal incision
• Tracheal suture
• Tracheostomy tube
• Type
• Size
• Length
• Skin closure

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Post-operative tracheostomy care

• Early complications
• Secretion ?( Nebulizer )
• Color, Quantity, Viscosity
• Dyspnea
• Infection
• Dysphagia
• Communication

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Long-term tracheostomy care

• Late complications
• Communication
• Home care
• Try off tube

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Indications for tracheostomy

• Upper airway obstruction
• Severe aspiration
• Prolonged intubation

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Advantages of tracheostomy

• Reduces patient discomfort
• Reduces need for sedation
• Ability to maintain oral and bronchial hygiene
• Reduces risk of laryngotracheal trauma
• Reduces dead space and work of breathing

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Immediate complications

• Apnea due to loss of hypoxic respiratory drive
• Bleeding
• Pneumothorax or pneumomediastinum
• Injury to adjacent structures
• Postobstructive pulmonary edema

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Tracheal incision
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Tracheal incision
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Tracheal incision
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Types of tracheostomy tube

• Material
• Metal (Silver-Stainless steel)
• Plastic (Polyvinyl chloride)
• Silicone
• Cuffed or Uncuffed
• Single or double tubes
• Fenestrated tubes

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Early complications

• Early bleeding
• Subcutaneous emphysema
• Plugging with mucus
• Displacement
• Atelectasis
• Tracheitis
• Cellulitis

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Late complications

• Bleeding
• Tracheomalacia
• Stenosis
• Tracheoesophageal fistula
• Tracheocutaneous fistula

• Granulation
• Scarring
• Failure to decannulate

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Home tracheostomy care

• Care for your stoma
• Clean the inner cannula
• Tracheostomy tube holder
• Know basic safety and what to do in an emergency

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Basic safety

• Bathing
• Trouble breathing
• Secretion
• Tube dislodgement
• Protection of foreign body

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Complications of tracheostomy

1. Immediate complications
2. Early complications
3. Late complications