2. • The post operative period begins from the time the patient
leaves the operating room and ends with the follow up visit by
the surgeon.
2
3. Purposes
• To enable a successful and faster recovery of the patient
post operatively.
• To reduce post operative mortality rate.
• To reduce the length of hospital stay of the patient.
• To provide quality care service.
• To reduce hospital and patient cost during post operative
period.
3
4. Complications
• Complications 5-40%
• Mortality <2%
• Complications are more frequent in emergency situations,
severely ill patients and young ones.
4
5. 1.Constant Supervision
• For bleeding, displacement, blocking of tubes, removing
secretions
• Pt given 100 % oxygen. Deflate the tube cuff.
5
6. 2.Suction
• Suction catheter with negative suction pressure (10 -15
mmHg) used.
• Catheter diameter should be < 1/3rd of internal diameter of
tracheostomy tube
• Catheter length introduced just enough to go beyond inner
tube (10 cm)
6
7. 3.Tracheostomy tube care
• Inner tube is removed & cleaned when blocked
• Outer tube never removed before 72 hrs to allow formation of
tracheo-cutaneous tract
• Cuff of Portex tube deflated for 10 minutes every 2 hours to
prevent pressure necrosis & dilatation of trachea
7
8. 4. Others
• Chest auscultated for confirmation of adequate suctioning. Re-
inflate cuff to a pressure of 25 mmHg. Patient oxygenated
again.
• Tracheostomy wound dressing done BID
• Steam inhalation TID. Moist gauze piece placed over
tracheostomy tube opening. Regular chest physiotherapy,
expectorants & mucolytics given.
8
9. 5.Prevention of crusting and tracheitis
• Proper humidification using humidifier or keeping boiling
kettle in room.
• Using a few drops of ringer lactate or normal saline or
hypotonic saline
• Every 2-3 hrs
9
10. Complications of tracheostomy
i. Immediate Complications (During tracheostomy)
ii. Intermediate Complications (Few hours or days later)
iii. Late Complications (Due to prolonged use of tube for
weeks-months)
10
11. Immediate complications
• Haemorrhage
• Aspiration of blood
• Injury to recurrent laryngeal nerve
• Injury to apical pleura (Pneumothorax)
• Injury to oesophagus (May cause tracheoesophageal fistula)
• Apnoea (Due to Carbondioxide wash out)
11
12. Intermediate Complications
• Haemorrhage
• Displacement of tube (Due to use of improper size tube)
• Blocking of tube (Due to excessive crusting/poor
humidification)
• Subcutaneous emphysema
• Tracheitis/Tracheobronchitis with crusting in trachea
• Pulmonary infections (Due to compromised airway defense
mechanism)
• Wound infection & granulation
12
13. Late Complications
• Haemorrhage (Due to erosion of major vessels esp
innominate/bracheocephalic art)
• Laryngeal stenosis (Due to perichondritis of cricoid cartilage)
• Tracheal stenosis (Due to tracheal ulceration & infection)
• Tracheoesophageal fistula (Due to erosion of trachea by tip of
the tube)
• Persistent tracheocutaneous fistula
• Difficult decannulation
13
14. Indications for changing
Elective:
• Facilitate weaning/speech production
• To increase patient comfort
• To allow non-routine cleaning and dressing of a tracheostomy
wound
• To allow treatment of granulation tissue at stoma site and/or
fenestration
Emergency:
• Blocked tube
• Misplaced or displaced tube
• Cuff failure Faulty tube
• Resuscitation
14
15. Care
• A healthy stoma should be clean and dry with pink edges,
though in the early postoperative period it is normal to see
dried blood around the stoma.
• Any redness, swelling, or pus is abnormal.
• A small amount of blood should be expected with each
tracheostomy tube change especially when a cuffed tube is
inserted or removed.
• The constant exposure of the stoma to secretions can be very
irritating to the skin so the stoma must be cleansed regularly
and kept dry.
15
16. Key pointsof dressingchangeare:
• Remove old dressing and tapes.
• Clean the stoma and surrounding area with saline and gauze.
• Dry the peri-stoma area.
• Apply keyhole dressing around the stoma/under flange of
tracheostomy tube.
• Apply transparent film dressing if required.
• Inspect dressing frequently.
• Change dressing when exudate visible
16
18. Frequency of suctioning
• It is commonly held that suctioning should be done only as
needed,
• In order to prevent obstruction of the tube and the
accumulation of secretions.
• In the early postoperative period the patient will require
frequent suction to clear secretions.
• This need will gradually settle as the trachea becomes
accustomed to the presence of the tracheostomy tube and the
patient learns to clear the secretions by coughing
18
19. Humidification
• Mucous membranes often require added moisture because
the tracheostomy tube bypasses the upper airway.
• Humidification can be provided by a tracheostomy collar, or
atomized saline.
• Lack of adequate humidification can cause the trachea to
develop squamous metaplasia, desiccation of the tracheal
mucosa, and impaired ciliary function.
19
20. The properties of an ideal humidifier
• Provision of adequate levels of humidification
• Maintenance of body temperature
• Safety
• Lack of microbiological risk to the patient
• Suitable physical properties
• Convenience
• Economy
20
21. Conclusions
• The most common indications for tracheostomy is mechanical
ventilation with prolonged tracheal intubation.
• Tracheostomy: emergency and elective, improve quality of life.
• Meticulous surgical technique.
• Appropriate postoperative tracheostomy care to reduce
complications.
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