tracheostomy

1. The lecture of Assistant Professor
Ann Kakabadze
Tracheostomy

8. Tracheostomy - is a surgical procedure
which consists of making an incision on
the anterior aspect of the neck and
opening a direct airway through an incision
in the trachea (windpipe)

9. Indications:
•Airway obstruction
Facial trauma
Head and neck cancers
Angioedema
Laryngeal dysfunction
Foreign body
Inflammatory conditions, neoplasms,
Obstructive sleep apnea
• The patient may be in a coma, or need a
ventilator to pump air into the lungs for a long
period of time
• Pulmonary Ventilation
• Pulmonary Toilet

10. Tracheostomy Tubes
A commonly used tracheostomy tube consists of three parts: outer cannula with flange (neck plate),
inner cannula, and an obturator The outer cannula is the outer tube that holds the tracheostomy open. A
neck plate extends from the sides of the outer tube and has holes to attach cloth ties or velcro strap
around the neck. The inner cannula fits inside the outer cannula. It has a lock to keep it from being
coughed out, and it is removed for cleaning. The obturator is used to insert a tracheostomy tube. It fits
inside the tube to provide a smooth surface that guides the tracheostomy tube when it is being inserted

12. Emergency tracheotomy:
when a person with a throat obstruction is not able to
breathe at all-no gasping sounds, no coughing-and only
after you have attempted to perform the Heimlich maneuver
three times without dislodging the obstruction
What you will need
•A first aid kit, if available
•A razor blade or very sharp knife
•A straw (two would be better) or a ballpoint pen with the
inside (ink-filled tube) removed. If neither a straw nor a pen
is available, use stiff paper or cardboard rolled into a tube.
Good first aid kits may contain "trache" tubes

13. Find the indentation between
the Adam's apple and the
Cricoid cartilage.
Make a half-inch horizontal
incision about one half inch
deep.
Pinch the incision or insert
your finger inside the slit to
open it
Insert your tube into the
incision, roughly one-half to
one inch deep

14. Nonemergency tracheotomy:
Upper Tracheostomy
Middle Tracheostomy
Inferior Tracheostomy

15. Types of tracheostomy:
1- Upper tracheostomy;
In the 1st and 2nd tracheal rings above
the isthmus of the thyroid gland
2- Middle tracheostorny;
In the 3rd and 4th trachea rings behind
the isthmus (operation of choice).
3- Inferior tracheostomy
in the 5th and 6th rings below the
isthmus.
1
2
3
4
5
6

16. Procedures of the operation:
Tracheostomy
1- Anaesthesia:
a) No anaesthesia in cyanosed patients and
urgent cases.
b) Local: Infiltration with 1% Novocain.
c) General: When there is no emergency (pre-
operarive).
2- Position:
Neck is extended and a sandbag is
put under the shoulders

17. 3- Incision:
a) Midline incision from the lower border of
the thyroid to the manubrium sterni
b) Cut the skin, superficial fascia, platysma
and the deep fascia connecting the
pretracheal muscles (sternohyoid and
sternothyroid) of the two sides.
c) Separate the pretracheal muscles of both
sides by a retractor .
Tracheostom
y
Procedures of the operation:

18. 4- The thyroid isthmus is divided between
2 kochers, transfixed by catgut to prevent
bleeding and leak of thyroxin and then
retracted.
5- Expose the trachea and inject 1/2 c.c
surface anaesthetic (pantrocaine 1%) in the
trachea to diminish the cough reflex
Tracheostom
y
Procedures of the operation:

19. 6- Fix the trachea and elevate it by a cricoid hook.
7- Open the trachea by an incision or by removal
of a circular part of the 3rd
and 4th rings.
8- Insert a suitable tracheostomy tube
9- Close the wound after ligating the bleeding
vessels
Tracheostom
y
Procedures of the operation:

23. Compliation of tracheostomy tube
Proper size
in position
Long tube causing
Injury of
esophagus
Long curve
causing
injury of both
oesophagus
& trachea.
Small tube causing
slipping out
&
surgical
emphysema
of neck.

24. Intraopertaive Early Late
•Bleeding and
injury to big
vessels
•Injury to
tracheoesophage
al wall
•Pneumothorex
•Bleeding
•Tracheostomy
tube obstruction
•Tracheostomy
tube
displacement
•Infection
•Tracheal
Stenosis
•Granulation
tissue
•Tracheocutaneu
s fistula
•Tracheo -
inominate fistula
Complications of
Tracheostomy

25. The risks associated with
tracheotomies are higher in the
following groups of patients
 Children, especially newborns and infants
 Smokers
 Alcoholics
 Obese adults
 Persons over 60
 Persons with chronic diseases or
respiratory infections
 Persons taking muscle relaxants ,
sleeping medications, tranquilizers, or
cortisone
•

26. Aftercare
Postoperative care
 A chest x ray is often
taken
 prescribe antibiotics to
reduce the risk of
infection
Home care
 patient and his or her
family members will
learn how clearing it
 Warm compresses can
be used to relieve pain
at the incision site
 The patient is advised
to keep the area dry
 It is recommended that
the patient wear a loose
scarf over the opening
when going outside