Tracheostomy

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Tracheostomy

  1. 1. TRACHEOSTOMY DR. A. NAVEED FRCS (Ed) ENT Department Tawam Hospital Al-Ain, Abu Dhabi U.A.E.
  2. 2. <ul><li>Tracheotomy </li></ul><ul><li>operative procedure that creates an artificial opening in the trachea. </li></ul><ul><li>Tracheostomy </li></ul><ul><li>c reation of permanent or semi permanent opening in trachea. </li></ul>
  3. 3. <ul><li>Anatomy </li></ul><ul><li>Trachea lies in midline of the neck extending from cricoid cartilage (C6) superiorly to the tracheal bifurcation at the level of sternal angle (T5). </li></ul><ul><li>Comprises 16-20 C shaped cartilage rings. </li></ul><ul><li>Length 10-12cm. </li></ul><ul><li>Diameter 15-20mm. </li></ul>
  4. 8. <ul><ul><li>Indications </li></ul></ul><ul><ul><li>Upper Airway Obstruction. </li></ul></ul><ul><ul><li>Pulmonary Ventilation. </li></ul></ul><ul><ul><li>3. Pulmonary Toilet. </li></ul></ul><ul><ul><li>4. Elective Procedure </li></ul></ul>
  5. 9. <ul><li>Upper Airway Obstruction </li></ul><ul><li>Trauma </li></ul><ul><li>Foreign body </li></ul><ul><li>Infections </li></ul><ul><li>Malignant lesions </li></ul>
  6. 10. <ul><li>Pulmonary Ventilation </li></ul><ul><li>Tracheostomy should be performed in a patient still requiring ventilation through an endotracheal tube for more than a one week. </li></ul>
  7. 11. <ul><li>Pulmonary Toilet </li></ul><ul><li>Those who cannot cough and clear their chest. </li></ul><ul><li>Prevent aspiration by low pressure high volume cuff tracheostomy tube. </li></ul>
  8. 12. <ul><li>Elective Procedures </li></ul><ul><li>For major head and neck operations. </li></ul>
  9. 13. Elective Tracheostomy Anaesthesia : G A Position: Supine with sand bag under the shoulder Incision :horizontal incision b/w cricoid cartilage and suprasternal notch. Division /retraction of thyroid isthmus Opening of Trachea and insertion of tube
  10. 14. <ul><ul><li>Emergency Tracheostomy </li></ul></ul><ul><ul><li>Within 2-4 mints with vertical incision </li></ul></ul><ul><ul><li>Cricothyrotomy/mini tracheostomy </li></ul></ul><ul><ul><li>Transverse incision over the cricothyroid membrane. Keep only for 3-5 days </li></ul></ul>
  11. 15. Pediatric Tracheostom <ul><li>Vertical incision in trachea b/w 2 nd and 3 rd ring. </li></ul><ul><li>No excision of ant. Wall of trachea </li></ul><ul><li>Secure the tube with neck by two sutures </li></ul>
  12. 16. Percutaneus Dilational Tracheostomy <ul><li>ICU Bed SideTracheostomy </li></ul><ul><li>Use of guide wire and Dilators </li></ul><ul><li>Under the vision of Bronchoscope through endotracheal tube </li></ul><ul><li>Less time ,Less Expensive </li></ul><ul><li>Not suitable for thick neck and in emergency </li></ul>
  13. 17. Complications of Tracheostomy <ul><li>Intraopertaive Complications. </li></ul><ul><li>Bleeding and injury to big vessels </li></ul><ul><li>Injury to tracheoesophageal wall </li></ul><ul><li>Pneumothorex </li></ul><ul><li>Early Complications </li></ul><ul><li>Bleeding </li></ul><ul><li>Tracheostomy tube obstruction </li></ul><ul><li>Tracheostomy tube displacement </li></ul><ul><li>Infection </li></ul>
  14. 18. <ul><li>Late Complications </li></ul><ul><li>Tracheal Stenosis </li></ul><ul><li>Granulation tissue </li></ul><ul><li>Tracheocutaneus fistula </li></ul><ul><li>Tracheo - inominate fistula </li></ul>
  15. 19. PROBLEMS DURING TRACHEOSTOMY CARE <ul><li>Dislocation of tracheostomy tube. </li></ul><ul><li>Bleeding from stoma or during suction. </li></ul><ul><li>Blockage of tracheostomy tube. </li></ul><ul><li>Aspiration and swallowing problems. </li></ul><ul><li>Speaking problems. </li></ul>
  16. 20. HOME CARE PLAN <ul><li>Education and training of the attendant. </li></ul><ul><li>Supply of dressing, suction catheters and suction machine. </li></ul><ul><li>When to come to the hospital. </li></ul><ul><li>Visit by community nurse. </li></ul>

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