TRACHEOSTOMY

Dr. Shahed Ali Sir

Definition → Tracheostomy is making an opening on the anterior wall of
trachea & converting it into stoma (opening/pathway) on the skin surface.
Function :-
 Attending pathway for breathing
 Improves Alveolar ventilation
 Protects the airway
 Permits removal of tracheobronchial secretion
 Intermittent positive pressure respiration
 To administer anesthesia
Types :-
 Emergency tracheostomy
 Elective tracheostomy
 Permanent tracheostomy
 Percutaneous dilatational tracheostomy
 Mini tracheostomy /Crico-thyroidotomy (3rd/4th ring suitable)
Indication:- 3 main
 Respiratory Obstruction
 Retained Secretion
 Respiratory insufficiency

Respiratory Obstruction
1. Infection :-
 Acute laryngotracheobronchitis
 Acute epiglottis
 Diphtheria
 Ludwig’s Angina
 Per tonsillr Abscess
 Retro/para pharyngeal Abscess
 Tongue Abscess
2. Trauma :-
 External injury of larynx and trachea
 Trauma due to endoscopy especially in infant and children
 Fracture of mandible or maxillofacial injury
3. Neoplasm→ Benign and malignant neoplasm of larynx, pharynx, upper
trachea, tongue and thyroid gland.
4. Foreign body larynx especially in children
5. Edema of larynx due to steam, irritant fumes or gases, allergy (Angio
neurotic edema or drug hypersensitivity), post radiation
6. Bilateral Abductor paralysis due to nerve injury or paralysis (Recurrent
Laryngeal nerve)
7. Congenital Anomalies :-
 Laryngeal web, cyst
 Tracheo esophageal fistula
 Bilateral Choanal atresia
Retained Secretion
1. Inability to cough :-
 Coma of any cause: head injury, stroke (cero vascular accident) and
narcotic overdose
 Paralysis of respiratory muscles-spinal cord injury, polio, Guillain Barre
Syndrome, Myasthenia Gravis
 Spasm of respiratory muscles-tetanus, eclampsia, Strychnine poisoning
2. Painful cough :-
 Pneumonia
 Chest injury
 Multiple rib fracture
3. Aspiration of Pharyngeal secretion :-
 Bulbar polio
 Polyneuritis
 Bilateral laryngeal paralysis
 Respiratory Insufficiency
Chronic lung complication :-
 Emphysema
 Chronic bronchitis
 Bronchiectasis
 Atelectasis
Complication :-
A. Immediate :-
 Hemorrhage
 Apnea (sudden cessation of respiration)
 Pneumothorax due to injury to apical pleura
 Injury to recurrent laryngeal nerve
 Injury to esophagus may result in tracheoesophageal fistula
 Aspiration of blood

B. Early/inter mediate :-
 Hemorrhage reaction any within 24hr or secondary (later)
 Displacement of the tube
 Blocking of tube
 Subcutaneous emphysema
 Trachealis’s and tracheobronchitis with thrusting in trachea
 Atelectasis and lung abscess
 Local wound infection

 Late-occurs with prolong use of tubes for weeks or months :-
 Hemorrhage due to erosion of major vessel
 Laryngeal stenosis due to perichondritis of cricoid cartilage
 Tracheoesophageal fistula
 Decannulation problem especially in childhood
 Persistent tracheocutaeneous fistula
 Tracheostomy scar
 Post-operative care of tracheostomy patient :-
1. Care of the patient :-
a. Patient is kept on propped up position
b. Oxygen inhalation
c. Constant supervision of patient for bleeding displacement or blocking of
tube (if occurs removal of secretion is essential)
d. Humidification of air by placing a normal saline gauze piece over the tube
 Wet gauze stitch should be placed on wound for maintaining
humidification
 IV fluid analgesic and antibiotic
 Periodic suction-every half an hour to remove secretion
2. Care of the tube :-
a. Fixation of tube not too tight or not to lose, tube should be placed
comfortably with a ribbon
b. Inner tube should be changed for cleaning
c. The tube should be removed or as possible after the problem is solved.
Observation for 2 days in hospital
d. Outer tube is not removed until 5 days to form stoma
3. Care of the wound :-

 Regular dressing
 Stitch off done after 7 days