TRACHEOSTOMY

DR. SRIDIP SAHA

DEFINITION

 TRACHEOTOMY--- Surgical opening of the trachea

 TRACHEOSTOMY----Creation of a stoma at the skin surface which leads into

the trachea
HISTORY

 It is the oldest surgical procedure

 It can be traced back in Egyptian era from 3600 BC

 1546: First well-documented tracheostomy by Antonius Musa Brasavola

 1921: Chevaliar Jackson- standardized the technique

 1969: Modern PCT developed by Toye and Weinstein

ANATOMY

 Trachea lies in midline of the neck extending from cricoid cartilage (C6)
superiorly to the tracheal bifurcation at the level of sternal angle (T5)

 Comprises 16-20 C shaped cartilage rings

 Becomes intra-thoracic at 6th cartilaginous ring

 Length 10-12 cm

 Diameter 15-20 mm
TYPES

 DEPENDING ON THE TIMING

1. Elective
2. Emergency
 DEPENDING ON THE CAUSE
1. Permanent
2. Temporary
 DEPENDING ON SITE
1. High
2. Mid
3. Low
INDICATIONS

 In head, neck and facial injuries

 Tetanus
 Tracheomalecia after thyroid surgery
 Laryngeal oedema, spasm, surgeries
 Major head and neck surgeries
 ICU ventilation
 Pulmonary toilet
STEPS

 Neck of the patient is hyperextended by placing sand bags under the shoulder
 A Transverse incision made1cm below the cricoid cartilage or halfway between
cricoid and the sternal notch
 Deep fascia is opened
 Strap muscles are retracted laterally
 Isthmus is divided or retracted below
 2nd and 3rd tracheal rings are opened and circular opening is made
 Tracheostomy tube is placed
 It is tied around the neck
RISK FACTORS FOR COMPLICATION

 Age: Infant and aged more than 75 years of age

 Obesitry
 Smoking
 Poor nutrition
 Recent illness like URTI
 Alcoholism
 Diabetes
COMPLICATIONS

 IMMEDIATE
1. Haemorrhage
2. Air Embolism
3. Apnea
4. Local damage to cartilage and nerve
5. Cardiac arrest
6. Pneumothorax
 LATE
1. Displacement of tube
2.Subcutaneous emphysema
3. Tracheal stenosis
4.T-O fitula
5. Dysphagia
TRACHESTOMY CARE

 Regular suctioning of the tube

 Cleaning of tracheostomy tube
 Humidification of the inspired air
 Skin and stoma care
CHANGING OF THE
TRACHEOSTOMY TUBE
 INDICATIONS: Soiled, blocked, cuff rupture

 Avoid within 1st week

 First tube changed by the surgeon

 Difficult cases (obese, short and thick neck) be prepared for endotracheal
intubation
HOME CARE

 Education and training of the attendant

 Should have suction catheter and suction machine

 Educate them when to come to hospital

DECANULATION

 Should be left in place no longer than necessary

 Reduce the size of the tube as soon as the patient condition permit

 Check for adequacy of the airway

 If occlution tolerated for 24 hours, the tube is removed

TRACHEOSTOMY TUBE

 FULLERS BIVALVED TRACHEOSTOMY TUBE

 JACKSONS TRACHEOSTOMY TUBE
 RED RUBBER TRACHEOSTOMY TUBE
 PVC TRACHEOSTOMY TUBE
THANK YOU