2. What is TEF?
Tracheal Esophageal Fistula (TEF) is a
developmental anomaly characterized by
abnormal connection between trachea and
esophagus.
3. What causes TEF?
The exact cause is unknown. TEF is commonly
found in infants with:
Congenital Heart Disease
Genitourinary Abnormalities
Imperforate Anus
Intestinal Atresia
CNS, Skeletal or Congenital Anomalies
4. What are the complications?
Aspiration of secretions into the lungs leading
to:
Respiratory distress
Pneumonia
Cessation of breathing
Death if untreated
5. TEF assessment & physical
findings:
History of prenatal polyhydramnios
Coughing and choking after eating
Respiratory distress (especially after feeding)
Crackle or wheeze lung sounds
Excessive salivation (requiring frequent
suctioning)
Emesis during the first feeding and with attempted
subsequent feedings
Imperforate anus
6. Diagnostics & Tests:
Prenatal ultrasonography (reveals absence of
stomach bubble or decreased intraluminal
fluid in the gut)
Chest X-rays
Abdominal X-rays
An upper GI with contrast
Esophagoscopy
7. Treatments:
Patient should be positioned upright
Suction catheter placement to reduce secretions
NPO
Gradual introduction of oral feedings (postop via NG
tube then orally after anastomoses heal).
I.V. fluids (10% dextrose & hypotonic sodium chloride)
Broad-spectrum antibiotics (also given post-op)
Oxygen therapy
8. Types of Surgery:
(based on the nature of the anomaly, the infant’s
condition and presence of coexisting congenital
defects)
Primary end-to-end anastomosis via thoracotomy
or thoracoscopy.
Gastrostomy (when primary anastomosis isn't
feasible).
Gastric pull-up (neoesophagus creation with
colonic tissue & extrathoracic elongation).
9. Nursing Interventions:
Maintain patent airway, administering O2 as needed.
Perform pulmonary physiotherapy.
Place infant in an upright sitting position and minimize handling.
Maintain the head upright to reduce the risk of aspiration.
Maintain NPO status.
Administer I.V. fluids and antibiotics as ordered.
Obtain daily weight.
Provide a humid environment.
Encourage caregivers to verbalize feelings and fears, participate in care,
and hold and touch their infant as much as possible.
Explain all treatments and care measures to the caregiver.
Postoperatively, provide aggressive pulmonary therapy (reduce risk of
respiratory infection & atelectasis).
Initiate oral feedings slowly as ordered.
10. Monitor before surgery:
Airway patency & respiratory status.
S/S of aspiration, infection and respiratory
distress.
Fluid balance and hydration (I & O).
Nutritional status & weight.
Coping strategies and Parent-infant
interaction.
11. Monitor after surgery:
Vital signs
Cardiopulmonary function
Surgical site
Chest tube function and drainage
Feeding tolerance
Nutritional status, including weight
Signs and symptoms of infection
Parent-infant interaction
12. Educate caregiver about:
TEF disorder, diagnosis and treatment.
Importance of maintaining NPO status before surgery
Postoperative feeding procedures and monitoring of
nutritional status via weight gain.
S/S of complications, aspiration and respiratory distress.
When to contact the Dr.
Proper positioning for the infant before and after surgery
The need for continued follow-up to evaluate the condition
and possible complications.
Refer infant and family to additional support and
resources.
