From elearn

TRACHEOSTOMY

A surgical incision into the trachea to insert a tube which a patient can breathe more easily & secretions can
be removed.

Purpose:

1. Allow a critically ill patient when threatened by a respiratory obstruction.

2. A prophylactic procedure so that secretions in the respiratory tract can be removed more effectively
before a patient’s breathing is severely compromised.
3. Decrease the amount of dead-air space in the airway and thus reduce the effort of breathing.
4. To utilize ventilator to breathe for the patient.
5. Provide and effective airway when swelling is expected. Ex. Surgery on the neck.

Indications:

1. Need for long term artificial airway.

2. Impassable upper airway obstruction.
3. Altered level of consciousness.
4. Inability to clear lower airway of secretions.
5. Need for continuous mechanical ventilation.
6. Prolonged endotracheal tube insertion.

Tracheostomy Tubes (3 parts)

a. Outer cannula
b. Inner cannula
c. Obturator

Size of the Tube-Standard: 0 to 12 French 24 to 44

• Made of plastic and metal. (Nonreactive plastic, stainless steel, sterling silver)
• No standard tracheostomy tube sizing but all packages indicate the inner and outer diameter in
millimetres.
• The length and curve of a TT is important. Long TT (ex. Hallinger tube, Shiley singlechannel and tube)
or short.
• Angled from 50 to 90 degrees short tubes is often used.
• The tubes’ curve must be in line with the trachea rather than press onto the anterior or posterior
wall of trachea.
• Inflated cuffs permit mechanical ventilation & protect the lower airway by creating a seal between
the upper and lower airways.
• Airway structures below the larynx are considered sterile.
• Always keep at the bedside a COMPLETE TRACHEOSTOMY TUBE SET OF THE CORRECT TYPE AND SIZE
FOR EMERGENCY REPLACEMENT.
• TT is used for long term airway management.