TRACHEOSTOMY DR. A. NAVEED FRCS (Ed) ENT Department Tawam Hospital Al-Ain, Abu Dhabi U.A.E.
operative procedure that creates an artificial opening in the trachea.
c reation of permanent or semi permanent opening in trachea.
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.
Upper Airway Obstruction.
3. Pulmonary Toilet.
4. Elective Procedure
Upper Airway Obstruction
Tracheostomy should be performed in a patient still requiring ventilation through an endotracheal tube for more than a one week.
Those who cannot cough and clear their chest.
Prevent aspiration by low pressure high volume cuff tracheostomy tube.
For major head and neck operations.
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
Within 2-4 mints with vertical incision
Transverse incision over the cricothyroid membrane. Keep only for 3-5 days
Vertical incision in trachea b/w 2 nd and 3 rd ring.
No excision of ant. Wall of trachea
Secure the tube with neck by two sutures
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
Complications of Tracheostomy
Bleeding and injury to big vessels
Injury to tracheoesophageal wall
Tracheostomy tube obstruction
Tracheostomy tube displacement
Tracheo - inominate fistula
PROBLEMS DURING TRACHEOSTOMY CARE
Dislocation of tracheostomy tube.
Bleeding from stoma or during suction.
Blockage of tracheostomy tube.
Aspiration and swallowing problems.
HOME CARE PLAN
Education and training of the attendant.
Supply of dressing, suction catheters and suction machine.