1) Tracheoesophageal fistula (TEF) is a congenital abnormality where the trachea and esophagus are connected by an abnormal passageway. There are different types depending on the location of the fistula. 2) Clinical manifestations include excessive salivation, coughing or choking with feeds, and respiratory distress. Diagnosis involves imaging studies and endoscopy to locate the fistula. 3) Surgical repair is usually required to separate the trachea and esophagus. Post-operative nursing care focuses on maintaining airway patency, feeding via gastrostomy tube, and preventing infections.

1. 11
Power point presentationPower point presentation
onon
TrachoEsophagial fistulaTrachoEsophagial fistula
(TEF)(TEF)
Submitted to:Submitted to: Resp. Manpreet sirResp. Manpreet sir
(paediatric lecturer(paediatric lecturer))
Submitted by:Submitted by: Kamaljit kaurKamaljit kaur
Bsc.nsg. 3Bsc.nsg. 3rdrd
yr.yr.
Roll no. 25Roll no. 25

2. 2
Learning objective:Learning objective:
• Definition
• Etiology
• Pathophysiology
• classification
• Clinical manifestation
• Diagnostic studies
• Complication
• Management
• Nursing management

3. 3
DefinitionDefinition
A tracheoesophageal fistula (TEF) is
a congenital or acquired
communication between the trachea
and esophagus.

4. 4
EtiologyEtiology
• Exact cause is unknown
• Some etiological factors include:
 Genetic factor
Teratogenic stimuli
Intrauterine environment
• These anomalies may develop due to deviation
of the septum bw oesophagus and tracheao or
altered growth of septum bw them.

5. 5
PathophysiologyPathophysiology
Etiological factors
Accumulation of saliva or feeds
in upper oesophageal pouch
Gastric secretions may
regurgitate through distal
fistula

6. 6
Abdominal distension occur due to air
entering the lower oesophagus through
fistula and passing into the stomach
during crying
Respiratory distress

7. 7
5 main categories of congenital5 main categories of congenital
TEFs:TEFs:

8. 8
ClassificationClassification
Type 1: EA without fistula. There is no
connection between esophagus to
traechea. The upper segment and lower
segment of esophagus is blind.
Type 2: EA with TEF(upper). Upper
segment of esophagus open into traechea
by fistula
Type 3:EA With TEF(lower). The distal
lower segment of esophagus connects
into trachea by fistula

9. 9
Type 4: EA with TEF both upper and lower
segment. There is EA with fistula bw both
proximal and distal ends of trachea and
esophagus
Type 5: H type TEF. Both proximal/ upper
and distal/ lower segment of esophagus
open into trachea by fistula. No EA
present

10. 10
Clinical featuresClinical features
• Excessive salivation
• Contant drooling
• Large amt. of secretion from nose
• coughing, gagging , choking and cyanosis
• Laryngospasm
• Difficulty in breathing
• Poor feeding

11. 11
Diagnosis of TEFDiagnosis of TEF
• Physical examination :Presence of air in
the gastrointestinal lumen with Percussion.
• Absence of gas in the abdomen suggests that
the patient has either atresia without a fistula or
atresia with a proximal fistula only
. Some clinicians prefer direct visualization by
flexible esophagoscopy or bronchoscopy
and assess its exact location prior to surgery.

12. 12
• Chest x-ray or passing radio opaque catheter
through esophagus: (A) Diagnosis of esophageal
atresia is confirmed when a 10-gauge (French) catheter
cannot be passed beyond 10 cm from the gums. (B) A
smaller-caliber tube is not used because it may curl up in
the upper esophageal segment, giving a false impression
of esophageal continuity.

13. 13
• USG: Prenatal 3D ultrasounds after 24
weeks may reveal polyhydramnios,
absence of fluid-filled stomach, small
abdomen, and a distended esophageal
pouch
• Bronchoscopy can also help to detect
the abnormalities.
• ECG or echocardiogram can be done to
detect associated cardiac anomalies.

14. 14
ComplicationComplication
Recurrent TEF( tracheomalacia)
Stenosis
Gastroesophagial reflux
Recurrent pneumonia
Airway hyperactivity

15. 15
ManagementManagement
Immediate management:
1) Attention to ventilation
2) Determine appropriate time for surgery.
3) For ↓ aspiration risk:
 Elevate neonate’s head at least 30º
 Suctioning can be done frequently to prevent aspiration.
 Gastrostomy is done to decompress the stomach &
afterwards to feed the the infant.
4) Supportive care include maintance of nutritional
requirements and warmth, preventions of infections,
antibiotic therapy, chest physiotherapy.

16. 16
Surgical management
• Thoractomy
• Gastrostomy
• Other surgical intervention include:
cervical oesophagostomy,
esophagocoloplasty,
esophagogastroplasty

17. 17
Nursing management:
Pre-operative care:
Prevent aspiration by positioning,
suctioning, thus reduce chance of
respiratory infection.
Monitor vital signs
Maintain fluids balance and intake output
chart
Provide emotional support to the parents.

18. 18
Post-operative care:
Maintain clear airway
Provide adequate feeding by IV or gastrostomy
feeding
Provide comfort measures to reduce pain
Maintain chest tube drainage with precautions.
Maintain hygiene
Monitors child’s conditions
Provide health edu. to the parents.

19. 19
Thank for your attentionThank for your attention