1. TRACHEOSTOMY
DR. A. NAVEED
FRCS (Ed)
ENT Department
Tawam Hospital
Al-Ain, Abu Dhabi
U.A.E.

2. Tracheotomy
• operative procedure that creates
an artificial opening in the
trachea.
Tracheostomy
• c reation of permanent or semi
permanent opening in trachea.

3. Anatomy
•
•
•
•
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.
Length 10-12cm.
Diameter 15-20mm.

8. Indications
1. Upper Airway Obstruction.
2. Pulmonary Ventilation.
3. Pulmonary Toilet.
4. Elective Procedure

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

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

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

12. 4. Elective Procedures
•
For major head and neck
operations.

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

14. • Emergency
Tracheostomy
Within 2-4 mints with vertical incision
• Cricothyrotomy/mini
tracheostomy
Transverse incision over the
cricothyroid membrane. Keep only
for 3-5 days

15. Pediatric Tracheostom
Vertical incision in trachea b/w 2nd and 3rd
ring.
No excision of ant. Wall of trachea
Secure the tube with neck by two
sutures

16. 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

17. Complications of Tracheostomy
Intraopertaive Complications.
Bleeding and injury to big vessels
Injury to tracheoesophageal wall
Pneumothorex
Early Complications
Bleeding
Tracheostomy tube obstruction
Tracheostomy tube displacement
Infection

18. Late Complications
Tracheal Stenosis
Granulation tissue
Tracheocutaneus fistula
Tracheo - inominate fistula

19. PROBLEMS DURING
TRACHEOSTOMY CARE
1.
2.
3.
4.
5.
Dislocation of tracheostomy tube.
Bleeding from stoma or during
suction.
Blockage of tracheostomy tube.
Aspiration and swallowing problems.
Speaking problems.

20. HOME CARE PLAN
1.
2.
3.
4.
Education and training of the
attendant.
Supply of dressing, suction
catheters and suction machine.
When to come to the hospital.
Visit by community nurse.