10/17/2009

Pengertian
TRAKEOSTOMI

Trakestomi adalah tindakan mebuat lubang

pada dinding depan/anterior trakea untuk
bernapas

OLEH
FAHRUN NUR ROSYID

Pembagian trakeostomi
Menurut letak stoma :
Letak yang tinggi dan letak yang rendah
batas letak adalah cincin trakea ke tiga
Menurut waktu tindakan
Trakestomi darurat
Trakestomi berencana

Indikasi Trakeostomi
Mengatasi obstruksi laring
Mengurangi ruang rugi (dead air space) di saluran napas atas
(rongga mulut, sekitar lidah dan faring)
Mempermudah penghisapan sekret dari bronkus pada pasien
yang tidak dapat mengeluarkan secara fisiologik (pasien
koma)
Untuk memasang respirator
Untuk mengambil benda asing dari subglotik, apabila tidak
mempunyai fasilitas untuk bronkoskopi

Alat-alat trakeostomi

Semprit dengan obat analgesia (novokain)

Pisau (skalpel)
Pinset anatomi
Gunting panjang yang tumpul
Sepasang pengait yang tumpul
Klem arteri
Gunting kecil yang tajam
Kanul trakea dengan ukuran yang cocok

Teknik trakeotomi

10/17/2009

A horizontal skin incision is marked midway between the cricoid

cartilage and the sternal notch. The skin is infiltrated with XylocaineEpinephrine to decrease the bleeding.

The skin incision is made with a Colorado Needle mounted on an electric knife (Bovie). A
steel blade scalpel is as good and is
preferred by many surgeons.

The isthmus of the thyroid gland is either retracted or divided in the midline. (In
this picture, the isthmus has been divided and retracted laterally, along with the
strap muscles.) The anterior tracheal wall is divided between the third and
fourth tracheal rings. A clamp is used to widen the tracheal opening.
The endotracheal tube is seen inside the tracheal lumen.

After incising the subcutaneous tissue and platysma, the strap muscles
are separated in the midline.
The strap muscles is a name given to the four infrahyoid muscles that
lie in front of the larynx. They are the sternohyoid, sternothyroid,
thyrohyoid and the omohyoid.

The tracheal wall incision is extended downward, bilaterally to form a

"trapdoor" flap. The flap is everted with an Allis clamp.

A silk suture is used to retract the trapdoor flap, making it easier to

insert the tracheostomy cannula, and preventing it from going
through a false passage into the mediastinum.

10/17/2009

While pulling on the silk suture to retract the trapdoor flap, the tracheotomy
cannula, with its cuff deflated, is inserted into the lumen of the trachea.

The cannula is sutured to the skin. An "accordeon" Racine adaptor is placed

on the cannula and connected to the anesthesia circuit.

10

A piece of Xeroform gauze is slit and placed around the tracheostomy Cannula.
Other tracheostomy dressigs are available and would do just as well.

11

Umbilical tape is inserted into the slots of the cannula and tied.

12
.

Side view of the "accordeon" adapter that connects to the anesthesia

circuit. (The patient's head is to the right side of the picture)

To prevent a tight fit around the neck, the umbilical tape is

tied over a finger, while the neck is flexed.

10/17/2009

Perawatan Pasca Trakeostomi

Penting, karena sekret dapat menyumpat
Sekret di trakea dan kanul harus sering dihisap
keluar
Kanul dalam dicuci sekurang-kurangnya 2 kali sehari
Lalu segera masukkan lagi ke dalam kanul luar
Bila kanul harus dipasang dalam jangka ewaktu yang
lama, maka kanul luar harus dibersihkan 2 minggu
sekali
Kain kasa dibawah kanul harus diganti setiap basah,
untuk menghindari dermatitis