Tracheostomy is a surgical procedure that creates an opening in the trachea to allow direct access to the breathing tube. It is one of the oldest surgical procedures, dating back to the 15th century. Tracheostomies can be temporary or permanent depending on the clinical situation and underlying condition. Potential complications include bleeding, infection, and damage to nearby structures like the thyroid cartilage. Care after tracheostomy involves dressing changes, tube changes or decannulation as appropriate for the patient's recovery.

1. DONE BY
P.SHRAVAN
CRI

2.  Tracheotomy : Surgical opening of the trachea.
 Tracheostomy : Creation of a stoma at the skin
surface which leads into the trachea.
 It is a surgically created airway fashioned by
making a hole in the anterior wall of the trachea.

4.  Tracheostomy is one of the oldest surgical
procedures.
 The first successful tracheostomy was
performed by Brasovala in the 15th century.
 In 1909, Chevalier Jackson : Guidelines for safe
tracheostomy.

7.  Temporary tracheostomy may be either elective
or emergency.
 An elective temporary tracheostomy may be
part of a planned procedure, such as a major
head and neck operation.
 An emergency temporary tracheostomy is a
rare procedure and is indicative in some certain
conditions.

8.  Permanent tracheostomy is an elective
procedure carried out as part of an operation
involving larynx or trachea.
 The trachea is permanently disconnected from
the pharynx and the proximal end of the trachea
is sutured to the skin.
 In a permanent tracheostomy the only access to
the lower airway is via the tracheostome.

9. Tracheotomy Indications
To bypass obstruction

10. Tracheotomy Indications
- Need for prolonged respiratory support, such as in
Bronchopulmonary Dysplasia
- To reduce anatomic dead space and increase the chance for
mechanical ventilation withdrawal
- To improve the patient`s quality of life (easier toilet,
ability to speak and eat, increase the mobility)
- Neuromuscular diseases paralyzing or weakening chest
muscles and diaphragm

11. Tracheotomy Indications
Miscellaneous
-Congenital abnormalities. (Pierre Robin, Triecher
Collins
syndromes)
- Obstructive Sleep Apnea Syndrome.
- Aspirations related to muscle or sensory problems.
-Prophylaxis (as preparation for extensive H&N
procedures, before radiotherapy for H&N CA)
-Cervical spinal cord injuries with respiratory muscles
paralysis.

12.  No absolute contraindications exist to
tracheostomy
 RELATIVE
 Laryngeal CA(strong)
 it may lead to increased incidence of stomal
recurrence(a diffuse infiltrate of neoplastic tissue at the junction
of the amputated trachea and skin )

13. Cricothyroidectomy
Cricothyroid
membrane
Crycoid cartilage
Thyroid cartilage
Landmark

14.  The patient lies supine with the neck extended over
a pillow.
 Ascertain the correct anatomical landmarks by palpation.
 The thyroid cartilage is gripped between the thumb and
middle finger of the left hand; in this position the index finger
can be used to palpate the cricothyroid membrane.
 Airway is entered using a needle and cannula attached to a 10
ml syringe half full of saline.
 The needle is angled in a caudal direction and the cannula is
passed over the needle into the trachea.

15.  Connect the cannula to an ambu bag using a syringe with a 7-mm
endotracheal tube adaptor.
 CO2 is not cleared effectively.

16.  Surgical tracheostomy (ST) is usually performed
in the operating room on a patient under general
anesthesia, but it may be performed at the bedside
in the intensive care unit.
 The patient’s shoulders are elevated with head
extension (unless cervical disease or injury is
present), elevating the larynx and exposing more
of the upper trachea.
 Local anesthesia with a vasoconstrictor is usually
infiltrated into the skin and deeper tissues

17.  The skin of the neck over the
2nd tracheal ring is identified,
and a vertical
incision about 2–3 cm in length
is created.
 Sharp dissection following the
skin incision is used to cut
across the platysma muscle,
and bleeding controlled by
hemostats and ties or
electocautery.

18.  Blunt dissection parallel
to the long axis of the
trachea is then used to
spread the submuscular
tissues until the thyroid
isthmus is identified
 If the gland lies superior
to the 3rd tracheal ring,
it can be bluntly
undermined and
retracted superiorly to
gain access to the
trachea

19.  There are 2 basic approaches
to tracheal entry.
 the 2nd tracheal ring is
divided laterally and the
anterior portion removed.
 Lateral sutures are used to
provide counter traction
during tracheostomy-tube
insertion.
 These are left uncut to
provide assistance if the
tube is accidentally
dislodged later.

20.  Tracheostomy tubes are available in a variety of sizes
and styles, from several manufacturers.
 Dimensions of tracheostomy tubes are given by their
inner diameter (ID), outer diameter (OD), length, and
curvature.
 Cuffs on tracheostomy tubes include high-volume low-
pressure cuffs, tight-to shaft cuffs, and foam cuffs.

22.  Tracheostomy tubes can be of either metal or
plastic.
 Metal tubes are constructed of silver or stainless
steel.
 Metal tubes are not used commonly because they
are
→ rigid construction
→ uncuffed
→lack a 15 mm connector for attachment to a
ventillator

23.  Plastic tubes are most commonly used and are
made from polyvinyl chloride or silicone.
 Polyvinyl chloride softens at body temperature
(thermolabile), adjustable to patient’s tracheal
anatomy and centering the distal tip in the
trachea.

24.  Cuffed tracheostomy tubes
→allow airway clearance,
→protection from aspiration
→ positive pressure ventilation
 It is recommended that cuff pressure be maintained
at 20–25 mmHg (25–35 cm H2O) to
minimize the risks for both
tracheal wall injury and aspiration.

26. Repeat X-Ray soft tissue neck
Strong Analgesia
Antibiotics
IV fluid until able to tolerate orally

27.  IMMEDIATE:-
 anesthetic complications.
 air embolism.
 apnoea.
 cardiac arrest.
 Hemorrhage- thyroid veins; jugular veins; arteries.
 local damage- thyroid cartilage; cricoid cartilage;
recurrent laryngeal nerve.

28.  INTERMEDIATE:
 - displacement of the tube.
 - surgical emphysema.
 - pneumothorax /pneumomediastinum.
 - infection: perichondritis.
 - tube obstruction by secretions or crusts.
 - tracheal necrosis.
 - tracheoarterial fistula.
 - tracheo-oesophageal fistula.
 - dysphagia.

29.  LONG TERM:
 - stenosis.
 - decannulation problems.
 - tracheocutaneous fistula.
 - disfiguring scar.

30. • Secretions in the trachea
• Suspected aspiration of gastric or upper airway
secretions
• Increase in peak airway pressures when on
ventilator
• Increase in respirations or sustained cough or
both
• Gradual or sudden decrease in ABG
• Sudden onset of respiratory distress when
airway patency is questioned
Indications For Suctioning

31.  After the track is formed – 4-5 days after
the operation.
 Rate of exchange depends on clinical
situation of the specific patient – type of
discharge, type of tube, medical status,
age..
 Usually every 14 days.
 Should be done by experienced staff.

32.  A tracheostomy speaking
valve is a one-way valve,
allows air in, but not out.
 This forces air around the
tracheostomy tube,
through the vocal cords
and the mouth upon
expiration, enabling the
patient to vocalize .

33.  Decannulation should be approached in a stepwise
fashion.
 if the initial cuffed tube has been changed there should
be enough airflow around the tube to allow the patient
to breath easily with the tube lumen occluded.
 Block the tube during the daytime initially, and then for
a full 24 hours, followed by decannulation.

34.  Once the tube has been removed the stoma must
be occluded with an airtight dressing.
 Change the dressing whenever an air leak
becomes apparent to avoid a persistent
tracheocutaneous fistula.
 Psychologically dependent patients require
longer duration for decannulation.