Tracheostomy

Definition:
Tracheostomy is a surgically created opening in the
neck leading directly to the trachea(the breathing
tube). It is maintained open with a hollow tube called
a tracheostomy tube.

Tracheostomy Tube
Objectives:
To bypass an obstructed upper airway.
To clean and remove secretions from the airway.
To more easily, and usually more safely, deliver oxygen
to the lungs.
Components of Tracheostomy Tube
Obturator- used to insert the outer cannula and is then
removed. It is kept at the patients bedside incase the
tube become dislodged and needs to be reinserted.
Cuffed Tracheostomy- surrounded by an inflatable cuff
that produces an airtight seal between the tube and the
trachea. This prevents aspirations of oropharyngeal
secretions and air leakage between the tube and trachea.
Low-pressure cuffs- commonly used to distribute a low,
even pressure against the trachea, thus decreasing the
risk of tracheal tissues necrosis.
 Obturator tracheostomy

Cuffed tracheostomy

Low pressure Cuffs

Procedure
1) The patient is made to lie down on their back with the neck & head extended by
keeping a pillow under the shoulder and neck.
2) Local anesthesia or general anesthesia is used for the procedure.
3) A horizontal cut is made across the neck above the 'sternal notch' using a knife.
4) The skin is separated and surrounding tissues are dissected to expose the trachea.
5) The 2nd or 3rd of the tracheal ring is incised for the tracheostomy tube to be
placed
6) A suitable size tracheostomy tube is then introduced inside. While choosing the
tube, the smallest feasible tube should be used. A general rule is that the tube
should be three fourths of the diameter of the trachea.
7) The cuff of the tube is inflated by using 2-5 ml of air and it is held in place by
using a necktie.
8) The incision is closed using skin sutures by the side of the tracheostomy tube.
9) Dressing is applied for the wound to heal.
Post Operative Follow-up Care
The surgeons will monitor the healing for several days
after the tracheostomy. Usually, the initial tube that was
placed at the time of surgery will be changed to a new
tube sometime between 10 and 14 days following surgery,
depending on the specific circumstances. Subsequent
tube changes are usually managed by the treating
physician or nursing staff.
Speech will be difficult until the time comes for a special
tube to be placed which may allow talking by allowing
the flow of air up to the vocal cords. Any time a patient
requires mechanical ventilation, air is prevented from
leaking around the tube by a balloon. Therefore, while
the patient is on a mechanical ventilator, he/she will be
unable to talk. Once the doctors are able to decrease
the-size of the tube, speaking may be possible. At the
appropriate time, instructions will be given. Oral
feeding may also be difficult until a smaller tube is
placed.
If the tracheostomy tube will be necessary for a long
period of time, the patient and family will be instructed
on home care. This will include suctioning of the
trachea, and changing and cleaning the tube. When the
time comes you will be provided with ample
information, instruction, and practice. Often, home
healthcare will be provided, or the patient will be
transferred to an intermediate health care facility.
In some cases (especially when performed during an
emergency or prolonged intubation) the tracheostomy
will not be a permanent situation. If the patient can
tolerate breathing without the tracheostomy tube the
surgical site can be closed, leaving a scar at the outside
of the neck.