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Tracheostomy
Tracheostomy
Dyspnea
Stridor
Voice change
Decreased or absent breath sounds
Restlessness
Hemodynamic instability (late)
Loss od consciousness (very late)
TRACHEOSTOMY
A vertical incision as an emergency measure for airway obstruction
A procedure to ventilate the lungs
Most common complication
airway stenosis
INDICATIONS
To bypass onstruction
Long-term mechanical ventialtion
Pulmonary toiletting Congenital anomaly
Neck trauma Upper airway foreign body
Tumor Supraglottic or glottic pathologic
Bilateral vocal cord paralysis condition
Laryngeal edema Subcutaneous emphysema
Respiratory failure Sever sleep apnea
Neurologic dysfunction requirement of mechanical
ventilation >7 days
Facilitation of major head and
neck surgery
Management of secretion
CONTRAINDICATIONS
Absolute Relative
Soft tissue infection of Sever respiratory
neck distress and refractory
Anatomic aberrations hypoxemia
Previous neck surgery Hypercapnia
Hematological
coagulation disorders
EQUIPMENTS
Tracheostomy tubes of appropriate type and size
Trach tube ties or velcro strap
Dressing supplies
Hydrogen peroxide, sterile water, normal saline
Water soluble lubricant
Surgilube or KY jelly
Blunt-end bandage scissors
Tweezers or hemostats
Sterile Q-tips
Trach care kits and/or pipe cleaners
Luer lock syringes for cuffed trach tubes
SURGICAL PROCEDURE
General anesthesia
Position
supine with a small shoulder roll to provide slight neck extension
Cuff of Endotracheal tube (ETT) is midway at the vocal cord level
1% lidocaine with 1:100,000 epinephrine solution
Horizontal or short vertical incision
Centered on the inferior border of the cricoid cartilage
Placement of Introducer needle
Minimal dissection onto pretracheal tissue
Larynx is stabilized and pulled cephalad
Bronchoscopy
Light reflex
Tip of needle directed caudad into the tracheal luman
Introduction of Guide wire, Stylet and Initial Tract Dilation
needle is withdrawn while keeping the cannula in the tracheal lumen
J-tipped guide wire placed under vision
Stylet placed with the safety ridge directed toward tip of wire
Tract dilated with 8 FR dilator
Dilation with the Blue Rhino Dilator
Loaded on the stylet; tip resting on safetly ridge
Dilator moved in and out
Placement of the Tracheostomy
loaded into dilator
Dilator is loaded on the safety ridge of stylet
Placed into tracheal lumen under direct visualization
Confirmation of placement
visualizing the carina
Securing the tube
2 sutures of 2-0 nylon on each side of the flange
Tracheostomy tape to hold tube in place
POST-OPERATIVE TRACHEOSTOMY CARE
Maintain patent airway
Frequent atraumatic suction
Humidification of inspired air and oxygen
Mucolytic agents
Coughing and physiotherapy
Occasional bronchial lavage
Prevent infection and complications
Aseptic tube suction, handling and tube changing
Prophylactic antibiotics
Deflate cuff for 5 minutes every hour
Avoid tube impinging on posterior tracheal wall
COMPLICATIONS
Immediate (0-24h)
Bleeding
Pneumothorax/Pneumomediastinum
Injury to adjacent structures
Intermediate (day 1-7)
Bleeding
Tube obstruction
Tube displacement/dislodgement
Subcutaneous emphysema
Atelectasis
Late (after day 7)
Bleeding
Tracheal stenosis
Tracheomalacia
Tracheo-esophageal fistula
Failure to de-cannulate
Type Description and Use