TRACHEOSTOMY

1. TRACHEOSTOMYTRACHEOSTOMY
Sanjay Kumar KulchaniaSanjay Kumar Kulchania
(LECTURER)(LECTURER)
M.M.INSTITUTE OFM.M.INSTITUTE OF
MEDICAL & NURSINGMEDICAL & NURSING
SCIENCESSCIENCES

2. TracheotomyTracheotomy
• operative procedure that createsoperative procedure that creates
an artificial opening in thean artificial opening in the
trachea.trachea.
TracheostomyTracheostomy
• ccreation of permanent or semireation of permanent or semi
permanent opening in trachea.permanent opening in trachea.

3. AnatomyAnatomy
• Trachea lies in midline of the neckTrachea lies in midline of the neck
extending from cricoid cartilageextending from cricoid cartilage
(C6) superiorly to the tracheal(C6) superiorly to the tracheal
bifurcation at the level of sternalbifurcation at the level of sternal
angle (T5).angle (T5).
• Comprises 16-20 C shapedComprises 16-20 C shaped
cartilage rings.cartilage rings.
• Length 10-12cm.Length 10-12cm.
• Diameter 15-20mm.Diameter 15-20mm.

8. IndicationsIndications
1.1. Upper Airway Obstruction.Upper Airway Obstruction.
2.2. Pulmonary Ventilation.Pulmonary Ventilation.
3. Pulmonary Toilet.3. Pulmonary Toilet.
4. Elective Procedure4. Elective Procedure

9. 1.1. Upper Airway ObstructionUpper Airway Obstruction
a. Trauma
b. Foreign body
c. Infections
d. Malignant lesions

10. 2.2. Pulmonary VentilationPulmonary Ventilation
• Tracheostomy should be
performed in a patient still
requiring ventilation through
an endotracheal tube for
more than a one week.

11. 3.3. Pulmonary ToiletPulmonary Toilet
• Those who cannot cough and
clear their chest.
• Prevent aspiration by low
pressure high volume cuff
tracheostomy tube.

12. 4.4. Elective ProceduresElective Procedures
• For major head and neck
operations.

13. Elective TracheostomyElective TracheostomyAnaesthesiaAnaesthesia: G A: G A
Position:Position: Supine with sand bag underSupine with sand bag under
the shoulderthe shoulder
IncisionIncision:horizontal incision b/w cricoid:horizontal incision b/w cricoid
cartilage and suprasternal notch.cartilage and suprasternal notch.
Division /retractionDivision /retraction of thyroid isthmusof thyroid isthmus
Opening of TracheaOpening of Trachea and insertion ofand insertion of
tubetube

14. • EmergencyEmergency
TracheostomyTracheostomy
Within 2-4 mints with vertical incisionWithin 2-4 mints with vertical incision
• Cricothyrotomy/miniCricothyrotomy/mini
tracheostomytracheostomy
Transverse incision over theTransverse incision over the
cricothyroid membrane. Keep onlycricothyroid membrane. Keep only
for 3-5 daysfor 3-5 days

15. Pediatric TracheostomPediatric Tracheostom
 Vertical incision in trachea b/w 2Vertical incision in trachea b/w 2ndnd
and 3and 3rdrd
ring.ring.
 No excision of ant. Wall of tracheaNo excision of ant. Wall of trachea
 Secure the tube with neck by two suturesSecure the tube with neck by two sutures

16. Percutaneus DilationalPercutaneus Dilational
TracheostomyTracheostomy
 ICU Bed SideTracheostomyICU Bed SideTracheostomy
 Use of guide wire and DilatorsUse of guide wire and Dilators
 Under the vision of Bronchoscope throughUnder the vision of Bronchoscope through
endotracheal tubeendotracheal tube
 Less time ,Less ExpensiveLess time ,Less Expensive
 Not suitable for thick neck and inNot suitable for thick neck and in
emergencyemergency

17. Complications of TracheostomyComplications of Tracheostomy
 Intraopertaive Complications.Intraopertaive Complications.
 Bleeding and injury to big vesselsBleeding and injury to big vessels
 Injury to tracheoesophageal wallInjury to tracheoesophageal wall
 PneumothorexPneumothorex
 Early ComplicationsEarly Complications
 BleedingBleeding
 Tracheostomy tube obstructionTracheostomy tube obstruction
 Tracheostomy tube displacementTracheostomy tube displacement
 InfectionInfection

18.  Late ComplicationsLate Complications
 Tracheal StenosisTracheal Stenosis
 Granulation tissueGranulation tissue
 Tracheocutaneus fistulaTracheocutaneus fistula
 Tracheo - inominate fistulaTracheo - inominate fistula

19. PROBLEMS DURINGPROBLEMS DURING
TRACHEOSTOMY CARETRACHEOSTOMY CARE1.1. Dislocation of tracheostomy tube.Dislocation of tracheostomy tube.
2.2. Bleeding from stoma or duringBleeding from stoma or during
suction.suction.
3.3. Blockage of tracheostomy tube.Blockage of tracheostomy tube.
4.4. Aspiration and swallowing problems.Aspiration and swallowing problems.
5.5. Speaking problems.Speaking problems.

20. HOME CARE PLANHOME CARE PLAN
1.1. Education and training of theEducation and training of the
attendant.attendant.
2.2. Supply of dressing, suctionSupply of dressing, suction
catheters and suction machine.catheters and suction machine.
3.3. When to come to the hospital.When to come to the hospital.
4.4. Visit by community nurse.Visit by community nurse.