TRACHEOSTOMY
A tracheostomy is a surgical opening in the anterior wall of the trachea just below the
larynx.It provides an alternative airway, bypassing the upper passages.
INDICATIONS
To provide and maintain a patent airway
To enable the removal of tracheobronchial secretions
To permit long term positive pressure ventilation
To improve patient comfort
To decrease the work of breathing and increase volume of air entering the lungs
TYPES OF TRACHEOSTOMY
Temporary
Permanent
Minitracheostomy
Cricothyroidotomy
TRACHEOSTOMY TUBES
A tracheostomy tube is Inserted through the tracheostomy to maintain a patent airway.
Secured in place by tapes tied around the neck
TYPES OF TRACHEOSTOMY TUBE
1. Uncuffed
2. Cuffed
3. Fenestrated
COMPONENTS OF TRACHEOSTOMY
sizes range from 2.5mm to 11 mm
curved tube
inflatable cuff
flanges with holes
tube bladder
CARING FOR THE PATIENT
Having a tracheostomy can be very traumatic and many patients find it difficult to adjust.
Patients with a new tracheostomy will need lots of support, reassurance and education
SURGICAL PROCEDURE
The procedure is usually done under general anesthesia in the operating room. However, if
the patient is sedated on a ventilator, it may be done under local anesthetic, even at the
patient's bedside
The patient is placed supine (on the back) with the head extended to expose the front of the
neck (Figure 3)
The incision is made over the second tracheal ring below the larynx. The incision may be
made from side to side or up and down
The underlying small muscles in front of the trachea are spread to the side
Sometimes the isthmus (thin middle portion) of the thyroid may have to be cut to expose the
second tracheal ring
Once the trachea is exposed, an incision is made through the second and sometimes third
tracheal cartilage rings. The incision may be in the form of a flap or a small segment the
tracheal ring may be removed
The tracheostomy tube, the metal or plastic tube to be placed in the trachea, is measured for
size to fit the trachea
As soon as the tube is pulled above the level of the second cartilage, the tracheostomy tube is
pushed into the trachea and directed downwards. The tube contains an obturator (central
portion) that has a cone shaped nose to guide the tube into the trachea. The obturator is
removed after the tube is inserted
The tracheostomy tube has a balloon at its end, which is inflated to prevent secretions from
getting into the lungs
The tube from the breathing machine or oxygen tube is connected to the tracheostomy tube.
Sutures are used to close the skin incision and a cloth tape is tied around the neck to secure
the tube
ARTICLES NEEDED:-
Suction apparatus-portable or wall suction
A clean tray containing
Sterile suction catheters
Infants 6-8F
Children 8-10F
Adults:12-16F
Sterile gloves/mask
Sterile N/S solution for flushing
Resuscitation bag
Sterile gauze pieces
Solution for disinfection
Kidney tray and paper bag
Sterile tracheostomy cleaning set
Cleaning solutions
Sterile blade/scissors
Tracheostomy ties/twill tape
Procedure:-
Assess the patient and look for any special instructions.
Explain procedure to the patient
Gather the equipments and provide privacy to the patient
Wash your hands
Assist the patient to semifowlers or fowlers position
Place the clean towel across the patients chest.
Turn the suction apparatus on
Adult: 100-120mmHg
Child: 95-110mmHg
Infant: 50 mmHg
Wear the goggles/mask/gown
Prepare the sterile articles
Hyper-oxygenate the patient
Wash hands
Wear the sterile gloves
Connect the sterile suction catheter to suction tubing which is held using unsterile
hand.
Moisten the catheter unless it is pre-lubricated using sterile N/S
Remove oxygen delivery system if present
Using sterile hands gently and quickly insert the catheter into the trachea (10-12.5cm
or until the patient coughs).Do not occlude the y port and apply pressure
Apply intermittent suction by occluding Yport with thumb of unsterile hand,gently
rotate the catheter as it is being removed.DO NOT ALLOW FOR MORE THAN
10sec.
Hyperventilate or encourage the patient to cough or take deep breath
Clean the catheter with the sterile gauze.
Flush the catheter with saline and repeat if necessary.
After procedure turn off the suction apparatus and disconnect the catheter and discard
Remove the previously applied soiled dressing with unsterile hand.
Applying clean dressing
Dip cotton dipped applicator in saline and clean stoma under faceplate
Apply betadine
Apply dressing
Change the tracheostomy tape
Remove gloves and discard
Wash hands
Assess patients repiratory status
Provide oral care
Document the procedure
PERI-OPERATIVE COMPLICATIONS OF TRACHEOSTOMY
haemorrhage
surgical emphysema
pneumothorax
air embolism
cricoid cartilage damage
nerve damage
COMPLICATIONS ASSOCIATED WITH TRACHEOSTOMY TUBE PLACEMENT
tracheal stenosis, ulceration, fibrosis, tracheomalacia
loss of normal humidifying and warming mechanisms
loss of physiological peep
increased risk of nosocomial pneumonia
SUMMARY
In this section we delt with respiration,tracheostomy, types,tracheostomy
tubes,indications,components of tracheostomy tub, complications of tracheostomy and
tracheostomy care.
CONCLUSION
A tracheostomy is a surgical procedure to create an opening through the neck
into the trachea (windpipe). A tube is usually placed through this opening to
provide an airway and to remove secretions from the lungs. This tube is called a
tracheostomy tube or trach tube
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