TRACHEOSTOMY AND CRICOTHYROIDOTOMY

Prepared by-Aalok thakurIntern,7th batchjmcth

TRACHEOSTOMY Making an opening in anterior wall of trachea and

converting it into stoma on the skin surface

FUNCTIONS OF TRACHEOSTOMY Alternative pathway for breathing Improves alveolar ventilation Protects the airway Permits removal of tracheobronchial secretions Intermittent positive pressure ventilation To administrate anaesthesia

INDICATION OF TRACHEOSTOMY Respiratory obstruction Retained secretion Respiratory insufficiency

TYPES OF TRACHEOSTOMY Emergency tracheostomy Elective tracheostomy Percutaneous dilatational tracheostomy Mini tracheostomy

TECHNIQUE Position

Supine position with pillow under shoulder

Anaesthesia No anaesthesia in unconciouss or emergency

patient 1-2%lignocaine with epinephrine GA

STEPS OF OPERATION A vertical incision is made in the midline of neck,extending

from cricoid cartilage to just above the sternal notch After incision tissues are dissected in midline. dilated veins are either ligated or displaced Strap muscles are seperated in midline and retracted

laterally Thyroid isthmus is displaced upward or divided between the

clamps and suture ligated A few drops of 4% lignocaine are injected into the trachea to

suppress the cough when trachea is incised Trachea is fixed with a hook and opened with a vertical

incision in the region of 3rd and 4th or 3rd and 2nd ring. this is then converted into circular opening

CONTD.. Tracheostomy tube is inserted and secured by tapes Skin incision should not sutured or packed Gauze dressing is placed between skin and flange of

the tube around the stoma

POST OPERATIVE CARE Constant supervision Suction Care of tracheostomy tube

COMPLICATION Immidiate

Haemorrhage Apnoea Pneumothorax due to injury to apical pleura Injury to recurrent laryngeal nerve Aspiration of blood Injury to esophagus

Intermitant Bleeding,reactionary or secondary Displacement of tube Blocking of stube Subcutaneous emphysema Local wound infection and granulation

CONTD.. Late

Haemorrhage due to erosion of major vessel Laryngeal stenosis Tracheal stenosis Tracheo-oesophageal fistula Problem of tracheostomy scar

CRICOTHYROIDOTOMY emergency procedure performed on patients with

severe respiratory distress in whom attempts at orotracheal or nasotracheal intubation either have failed or were deemed to have an unacceptable level of risk

INDICATION Inability to intubate Inability to ventilate Severe facial or nasal injuries (that do not allow oral

or nasal tracheal intubation) Massive midfacial trauma Possible cervical spine trauma preventing adequate

ventilation Anaphylaxis

PROCEDURE Using IV cannula

14 gauge iv cannula introduced into the lumen of trachea with patent neck in extended position

Cannula is then directed and advanced aaudally and the needle removed

Using a scalpel Thyroid is steadied with thumb and middle finger of the left

hand and cricothyroid space identified with index finger of right hand

Scalpel is used to cut the skin, subcutaneous tissue, and cricothyroid membrane horizontally to enter the subglottic area and then turned vertically to admit a thin endotracheal tube

CONTD.. Using a cricothyrotome or mini-tracheostomy set

mini-tracheostomy set is used

CONTRINDICATION Inability to identify landmarks (cricothyroid

membrane) Underlying anatomical abnormality (tumor) Tracheal transection Acute laryngeal disease due to infection or trauma Small children under 10 years old (a 12–14 gauge

catheter over the needle may be safer)

COMPLICATION esophageal perforation occurs when the blade

penetrates too deeply subcutaneous emphysema may occur if the

horizontal incision is too wide, allowing air to become trapped in the subcutaneous tissue

hemorrhage may occur if a vessel is ruptured

POSTOPERATIVE CARE chest x-ray film to confirm placement of the

tracheostomy tube respiratory therapy so the patient can be

mechanically ventilated Tracheostomy tube placed during an emergency

cricothyroidotomy can be left in place for up to 72 hours.