TRACHEOSTOMYTRACHEOSTOMY

Miss H.Babar-CraigMiss H.Babar-Craig

Indications for a Indications for a TracheostomyTracheostomy

1 . AIRWAY OBSTRUCTION:1 . AIRWAY OBSTRUCTION: Congenital - subglottic stenosis, webs, Congenital - subglottic stenosis, webs,

cystscysts Trauma - foreign bodies, burns, corrosiveTrauma - foreign bodies, burns, corrosive Infection – epiglottitis, Ludwig’s angina, Infection – epiglottitis, Ludwig’s angina,

croupcroup Tumour – tongue, larynx, pharynx, thyroidTumour – tongue, larynx, pharynx, thyroid Vocal Cord ParalysisVocal Cord Paralysis

Indications for Indications for TracheostomyTracheostomy

2. PROTECTION OF AIRWAY :2. PROTECTION OF AIRWAY : Neurological diseases – bulbar palsy, Neurological diseases – bulbar palsy,

MS, MGMS, MG Trauma – burns, facial fracturesTrauma – burns, facial fractures Coma – head injury, CVA, overdoseComa – head injury, CVA, overdose Head & Neck surgeryHead & Neck surgery 3. VENTILATORY SUPPORT3. VENTILATORY SUPPORT Usually day10 on ITUUsually day10 on ITU Excessive airway secretionsExcessive airway secretions

Surgical TracheostomySurgical Tracheostomy Chevalier Jackson 1909Chevalier Jackson 1909 Horizontal incision midway between sternal Horizontal incision midway between sternal

notch and cricoid cartilage ( 2 fingerbreadths notch and cricoid cartilage ( 2 fingerbreadths above sternal notch). Through skin, above sternal notch). Through skin, subcutaneous tissue and platysma.subcutaneous tissue and platysma.

Midline Vertical incision to separate Midline Vertical incision to separate sternohyoid, sternothyroid to reveal thyroid sternohyoid, sternothyroid to reveal thyroid isthmus. This is suture ligated to reveal isthmus. This is suture ligated to reveal trachea.trachea.

1 cm1 cm22 Section of 2 Section of 2rdrd or 3 or 3thth tracheal ring tracheal ring removed.removed.

ComplicationsComplications

1. Hemorrhage, pneumothorax, surgical 1. Hemorrhage, pneumothorax, surgical emphysaema, recurrent laryngeal nerve emphysaema, recurrent laryngeal nerve damage.damage.

2. Tube displacement2. Tube displacement 3. Tube obstruction – mucous plug 3. Tube obstruction – mucous plug 4. Long term - Tracheal stenosis 4. Long term - Tracheal stenosis

( mucosal ischaemia due to over ( mucosal ischaemia due to over inflation of balloon), tracheo-innominate inflation of balloon), tracheo-innominate fistula, tracheocutaneous fistula.fistula, tracheocutaneous fistula.

Tracheostomy SiteTracheostomy Site

Tracheostomy TubesTracheostomy Tubes

CUFFED TUBECUFFED TUBE For protection of airway from For protection of airway from

aspiration or hemorrhageaspiration or hemorrhage INNER TUBESINNER TUBES Facilitates cleaning and removal of Facilitates cleaning and removal of

crusted secretionscrusted secretions FENESTRATED TUBESFENESTRATED TUBES Allows air to flow up to glottis – speechAllows air to flow up to glottis – speech

TracheostomyTracheostomy

Tracheostomy TubesTracheostomy Tubes

SYNTHETIC TUBESSYNTHETIC TUBES Most are made from PVC, silicone, Most are made from PVC, silicone,

plasticplastic Two main types 1. SHILEYTwo main types 1. SHILEY

2. PORTEX2. PORTEX

They have low pressure cuffsThey have low pressure cuffs

CHILDREN do NOT have cuffed tubes CHILDREN do NOT have cuffed tubes due to tracheal necrosis- subglottic due to tracheal necrosis- subglottic stenosisstenosis

Tracheostomy TubesTracheostomy Tubes SIZES size10 – 4 ( more plugging small SIZES size10 – 4 ( more plugging small

tubes)tubes) ADJUSTABLE FLANGES : for people with ADJUSTABLE FLANGES : for people with

long distance from skin to trachea.long distance from skin to trachea. TRACHEAL BUTTON : for weaning off TRACHEAL BUTTON : for weaning off

tracheostomy, protocol for weaning.tracheostomy, protocol for weaning. One way speaking valves – valve opens One way speaking valves – valve opens

during inspiration on superior curve of during inspiration on superior curve of tubetube

Humidification : Swedish nose, to prevent Humidification : Swedish nose, to prevent crustingcrusting

Tracheostomy TubesTracheostomy Tubes

PERMANENT TUBESPERMANENT TUBES Metal ( Silver) Tubes -Metal ( Silver) Tubes -

Chevalier Jackson and NegusChevalier Jackson and Negus

They have fenestrations and inner They have fenestrations and inner tubes.tubes.

Easier to clean.Easier to clean.

Tracheostomy TubesTracheostomy Tubes

PROBLEMSPROBLEMS 1. Infection1. Infection 2. Mucous plugging2. Mucous plugging 3. Require humidification3. Require humidification 4. Regular suctioning4. Regular suctioning 5. Swallowing problems due to 5. Swallowing problems due to

indenting of indenting of

oesophagusoesophagus