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  1. 1. Tracheostomy
  2. 2. Upper and Lower Respiratory System
  3. 3. What is a tracheotomy? it’s involves surgical creation of an externalopening through the 2nd and 3rd or 3rd and 4thring of the trachea
  4. 4. A Tracheostomy can be- Temporary,- Permanent or- placed during Emergency.
  5. 5. Cricothyrotomyis an emergency tracheotomy that mayalso be performed when endotracheal intubation is impossible
  6. 6. Indications for Tracheostomy : 1. Airway Obstruction
  7. 7. CongenitalEx: larynx hemangioma Ex: Sub glottic or tracheal stenosis,
  8. 8. Foreign body aspiration Ex: Swallowed or inhaledobject lodged in upper airway
  9. 9. InfectionEx: Acute epiglottitis,It is an infection of theepiglottis andsupraglotticstructures.
  10. 10. 2. Airway Clearance:clears the secretions that cannot be cleared due toweakness and conditions requiring long term airwaysupport, like progressive neurological conditions such as:Severe brain injury ….ect
  11. 11. 3.Long Term Intubation:
  12. 12. What is considered Long TermIntubation for an adult and pediatricpatient??? Adult: Intubated more than two weeks. Pediatric: Intubated more than 3-4 weeks.
  13. 13. 4. Elective/Prophylactic1- During major head and neck surgery 2- Radiation treatment
  14. 14. What physiological changes occur with a tracheostomy???
  15. 15. temporary voice loss. loss of the airborne particlefiltration, warming and humidification action of the nose. potential impairment of swallowing. Mucociliary transport and cough mechanisms are impaired.
  17. 17. Surgical tracheostomy performed in patients with:1. Tumors of the upper airway2. Previously failed/difficult percutaneous procedure3. Major vascular structures at risk4. Anatomical abnormality (e.g. goiters)5. Short neck6. Morbid obesity7. Emergency airway
  18. 18. Goiters is a swelling of the thyroid gland, which can lead to a swelling of the neck or larynx (voice box)
  19. 19. Nursing ConsiderationsIn (ST), the pt may come back with stay suturesaround the tube - to hold or manipulate the operating area.In ST sutures are removed after the firsttracheostomy tube change - 5-7 days of theinsertion, while the stoma is forming or asordered by the operating surgeon.
  20. 20. stay sutures done:to prevint accedint accidentally dislodged.
  21. 21. Percutaneous insertion: The first tube change should not be performed before 2weeks of the initial insertion??because the stoma is very tightand the risk of the tracheotomy collapsing is high.
  22. 22. Holistic Nursing Considerations During the first 2-3 days…the patient is uncomfortable due to trauma of surgery, pain of a freshincision, choking, presence of a foreign object in his trachea and inability to communicate through speech.
  23. 23. keep in mind .. thepatient is more than a “trach tube!”1- pain management. 2- reassurance. 3- education
  24. 24. What are the risks involved in tracheostomy?1-Reactions to medication andanesthesia.2-Uncontrollable bleeding.3-Respiratory problems.4-Possibility of cardiac arrest.
  25. 25. What are the complications of a Tracheostomy?Early ( Life-threatening ) Late Infection : Accidental tube displacement 1- stoma site 2- chest- 50-60% of tracheostomy patients may develop nosocomial pneumonia Blocked tracheostomy tube Skin breakdownDamage during surgery - possible hemorrhage. Tracheal stenosis Sx emphysema Tracheo-esophageal fistula : 1- Abdominal distention Trauma 2- Liquid food suctioned through tracheostomy tube. Pneumothorax
  26. 26. What are the parts of the tracheostomy tube?
  27. 27. Parts of Tracheostomy Tube Part Main features Outer canula Main body of the tube cuff A balloon at the distal end of the tube, provide seal between the rachea & tube Pilot balloon External balloon connected to the inflation line to the internal cuff ( vice versa) Flange/ neck plate Support the main tube structure. Tube type, size & coudeIntroducer/ obturator Bevel, smooth rounded dilating tip tipped placed inside the inner canula of the tube during insertion. ( reduce the risk of trauma ) removed once the tube in correct placement 15 mm adaptor Allow attachment to ventilation equipment/ ambu- bag
  28. 28. Types of tracheostomy tubesSingle lumen:- Larger inner diameter than double lumentube.- Absence of removable inner cannula.Double lumen:- Removable inner cannula (twist-lockconnection ) prevent build up of secretion.
  29. 29. Cuffed t.t indication contraindication Risk of aspiration Child < 12 years oldNewly formed stoma ( adult ) Risk of tracheal tissue damage from cuff PPV Unstable condition
  30. 30. Indication cuff cuffless Minemiz aspiration No risk for aspiration Allow PPV ( one way valve ) Pt no longer need PPVClose system ( upper & lower airway ) Pt still need airway access Minemiz emphysema
  31. 31. Indication Close Suction System:- Pt regyuireing Highy PEEP, Fio2- TB, ARDS- To Avoiding dramatic drop in oxygen.
  32. 32. Fenestration:Single or multiple holes in the superiorcurvature of the shaft of outer and innercannula.Indication:- Improve speech & swallowing function.
  33. 33. Occlusion cap:Soolid piece of plasticc can be placedon the end of a 15mm hub.Indication :Blocks all air flow via tracheostomy(end stage weaning )
  34. 34. Humidification:1- pt requiring oxygen with excessivesecretion/bedridden ( continuous ATM ) with needto be labeled, dated and changed as per PP.2- alert mobiles pt with minimal secretion ( HME )change Q 24hr.3- buchannan bib ( contains a special foam(hydrolox) which act as filter & HME. Shoud byChange/washed up to 3 use’s only.
  35. 35. Nursing Considerations..
  36. 36. Condition of tracheostomy dressing wet/dryStoma site should be observed for:- Bleeding- Increase stoma size- Appearance of stoma edges and tissue( e.g. maceration, cellulites)- Evidence of infection (purulent discharge, pain,offensive odor, tenderness- Allergic reaction to dressing product- Tube secured to skin, ties are appropriately tightPatient on oxygen: TM T-piece, humidification -method.
  37. 37. Suctioning Indications for Suctioningif pt have one or more of the following :Excessive secretionsDecreased oxygen saturationsTachypnea , bradypnea or tachycardiaRestlessness, increased use of intercostal muscles, or sweatingNoisy breath sounds/decreased breathsoundPoor ineffective coughChange in skin color from baselineReduced expired air flow from tubeduring expirationCollection of sputum specimens
  38. 38. Prior to section:- hyperventelation - hyperoxygenation to Reduse Hypoxemia.
  39. 39. Caution:COPD: patients shouldonly have 20% increaseof oxygenation.Hyperventelation , willbe used for non-spontaneous breather,as it may have significantadverse effects .Ex: Reduced venousreturn and barotraumas
  40. 40. Potential Complications of Suctioning:- Hypoxemia- Hypotension- Increased intracranial pressure- Hyper/Hypoventilation- Cardiac arrhythmias- Increased work of breathing- Bronchospasm- Infection- Accidental extubation/decannulation- Cardiac Arrest
  41. 41. Famous People who was tracheostomies
  42. 42. King Fahd bin Abdul Aziz Al Saud John Fitzgerald Kennedy (U.S. President)(king of SA)
  43. 43. Thank youdone by :Marwah M.Ibrahim
  44. 44. Any QuestionReferences- American Journal of Critical Care.- Tracheostomy multiprofessional handbook (1edaddition ).- Critical Care Nurse.