This document discusses tracheostomy, including its definition, indications, procedures, types of tubes, care, and complications. A tracheostomy is a surgical opening into the trachea to allow direct access to the breathing tube. It may be performed to protect the airway, treat respiratory failure or retain secretions. The procedure involves making an incision in the neck and inserting a tracheostomy tube. Tube types include cuffed, uncuffed, and fenestrated. Ongoing care and monitoring for complications is important.

2.  Definition
 Indications
 Procedure
 Types of tracheostomy tubes
 Tracheostomy care
 Complications
 Cricothyrotomy
 Percutaneous tracheostomy
 Decannulation

3. Tracheostomy :
• creation of permanent or
semi permanent opening
in trachea to maintain
airway patency.

4.  First mentiones in Rig Veda – 2000 BC
 Egyptian manuscipts- 3500 yrs ago.
 Fabricius (1617) & Habicot (1620)- first
technical descriptions.
 Heister (1718) – introduced term
“tracheotomy”
 Negus (1938)- coined term “tracheostomy”

5.  Temporary
Temp or permanent
Elective or emergency
 Permanent
Laryngectomy
Diversion procedure

6. 1. Impending upper airway obstruction
2. Major laryngeal trauma
3. Prolonged intermittent positive pressure ventilation
4. Inability to intubate or perform cricothyrotomy
5. Laryngeal foreign body or pathology
6. Hypercarbia/ hypoxemia due to flail chest/ lung
contusions.
7. When IPPV- for control of cerebral edema in head
injuries.

8. PROTECTION of AIRWAY
› Neurological Diseases(Polyneuritis eg GBS, MN
Diseases)
› Coma (GCS<8, risk of aspiration)
RESPIRATORY FAILURE
› Pulmonary Disease
› Flail Chest
RETENTION of SECRETIONS
› In acute resp. infection, pulmonary disease etc
Elective Tracheostomy as Adjunct to H&N
surgeries
› >21 days on ETT
› <14 days on ETT(relative)

9. Anaesthesia
› LA
› GA
Incision
› Transverse
› Longitudinal
Positioning
› Supine
› Shoulder pad
› Head ring

10. Skin Prep with
povidine iodine,
chlorohexidine(sa
vlon)
Draping
Good light source
and suction
machine ready
and tested to be
functional

11. Blunt dissection of
subcut tissue
Transversely
Retracted as shown

12. Transverse Incision
2-4cm below cricoid
cart/ 2-4cm above
suprasternal notch
Incision length=
anterior border of
SCM msc lateral
Blunt dissection of
subcut

13. Strap msc is
divided
longitudinally
at midline

14. Langerbeck
retractor used to
retract laterally

15. Thyroid isthmus is
divided at midline
by 2 haemostat
and cut edge
secured by 2/0
vicryl
Thyroid retracted
superiorly

16. Depending on the
the TT size abt 4cm
longitudinal opening
is made to trachea
below 2nd ring

17. Negus
tracheal
dilator
applied and
TT inserted
in between

18. Tube is
anchored

20.  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

21.  Cuffed tubes
 Un-cuffed
 Fenestrated
 Inner cannula
 Adjustable flange
 PVC, Silver, Silicone and Rubber
 Mini Tracheostomies

22. Metallic tube

23. Fenestrated
tracheal tube
 Allow patient to
ventilate past tube via
upper airway
 Allow speech

24.  Allows ventilation and
prevents aspiration
 High cuff pressure can
be damaging
 Check pilot cuff
 DO NOT BLOCK THIS
TUBE

26.  Maintains airway once
aspiration risk has
passed
 Increase airflow to the
larynx
 Which patients:
› Long term
tracheostomy pts
› Patients who do not
require a seal
› Paediatrics

28. Neck collar

29. Thyroid cartilage
Cricothyroid
membrane
Crycoid cartilage

30. 1 2 3
4 5

32. › Convert to trach
› Keep only for 3-5 days
› Complications –
 Subglottic oedema
 Surgical emphysema
 Perichondritis
 Infection
 VC injury
 Stenosis

33.  Small skin incision – second to third
rings
 Some blunt dissection
 14 G cannula with syringe
 Guidewire through cannula
 Dilators / Dilating forceps
 Tracheostomy tube with obturator

34.  Contraindications
› Children
› Bleeding diathesis
› Previous surgery
› Infection
 Dangerous in :
› Short neck
› Thick & fat neck
› Enlarged thyroid /
swelling

35. Intraopertaive Complications
 Bleeding and injury to big vessels
 Injury to tracheoesophageal wall
 Pneumothorax
 Apnea
 Cardiac arrest
Early Complications
 Bleeding
 Tracheostomy tube obstruction
 Tracheostomy tube displacement
 Infection

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

39.  Stepwise
 Uncuff ,
 Downsizing if neccessary
 Airtight dressing