TRACHEOSTOMY & TRACHEOSTOMY & CRICOTHYROIDOTOMYCRICOTHYROIDOTOMY
DR FRANK EDWINDR FRANK EDWIN
INTRODUCTIONINTRODUCTION
Tracheostomy is an operative Tracheostomy is an operative procedure that creates a surgical procedure that creates a surgical airway in the cervical trachea airway in the cervical trachea
It is considered synonymous with It is considered synonymous with tracheotomy tracheotomy
LARYNX & TRACHEALARYNX & TRACHEA
ANATOMY IANATOMY I
ANATOMY IIANATOMY II
ANATOMY IIIANATOMY III
ANATOMY IVANATOMY IV
UPPER AIRWAY OBSTRUCTION -UPPER AIRWAY OBSTRUCTION -RECOGNITIONRECOGNITION
Dyspnea Dyspnea Stridor Stridor Voice change Voice change Decreased or absent breath sounds Decreased or absent breath sounds Restlessness Restlessness Hemodynamic instability (late) Hemodynamic instability (late) Loss of consciousness (very late) Loss of consciousness (very late)
INDICATIONS FOR INDICATIONS FOR TRACHEOSTOMYTRACHEOSTOMY
To bypass obstruction To bypass obstruction Long-term Mechanical ventilationLong-term Mechanical ventilation Pulmonary toilettingPulmonary toiletting Neck trauma Neck trauma Tumor Tumor Bilateral vocal cord paralysis Bilateral vocal cord paralysis Laryngeal EdemaLaryngeal Edema Respiratory failureRespiratory failure
FORMS OF TRACHEOSTOMYFORMS OF TRACHEOSTOMY
Emergency tracheostomyEmergency tracheostomy
Urgent tracheostomyUrgent tracheostomy
Elective tracheostomyElective tracheostomy
INTRAOPERATIVE DETAILS:INTRAOPERATIVE DETAILS:TRACHEOSTOMYTRACHEOSTOMY
TRACHEOSTOMYTRACHEOSTOMY
TRACHY TUBESTRACHY TUBES
TUBE PARTSTUBE PARTS
METALIC TUBESMETALIC TUBES
PLASTIC TUBESPLASTIC TUBES
USE OF FENESTRATED TUBEUSE OF FENESTRATED TUBE
Chest X-ray Chest X-ray after trachyafter trachy
POSTOPERATIVE DETAILSPOSTOPERATIVE DETAILS
Postoperative care is critical. Postoperative care is critical.
Copious secretions is the normCopious secretions is the norm
Suctioning every 15 minutes may be Suctioning every 15 minutes may be requiredrequired
Suctioning should be shallow initially Suctioning should be shallow initially
Suctioning should be limited to no more Suctioning should be limited to no more than 15 secondsthan 15 seconds
POSTOPERATIVE DETAILS 2POSTOPERATIVE DETAILS 2
Humidified oxygen helps prevent Humidified oxygen helps prevent inspissation of the secretions.inspissation of the secretions.
Mucolytic agents may be employed.Mucolytic agents may be employed.
If uncorrected, mucus plugging of the If uncorrected, mucus plugging of the
inner cannula can cause a life-inner cannula can cause a life-threatening obstruction. threatening obstruction.
POSTOPERATIVE DETAILS 3POSTOPERATIVE DETAILS 3
The original tube is left sutured in place The original tube is left sutured in place for 5-7 days to allow the tract to heal. for 5-7 days to allow the tract to heal.
Then the sutures are removed, and the Then the sutures are removed, and the tube is replaced. tube is replaced.
The site should be kept clean and dry to The site should be kept clean and dry to minimize infectionminimize infection
Patient and family education should begin Patient and family education should begin ASAPASAP
FOLLOW-UP CAREFOLLOW-UP CARE Speaking: should be encouraged when Speaking: should be encouraged when
cuff is deflated cuff is deflated
Swallowing: Swallowing is more difficultSwallowing: Swallowing is more difficult
Evaluate risk of aspiration before feedingEvaluate risk of aspiration before feeding
Educate: both patient and familyEducate: both patient and family
Equipment: for dischargeEquipment: for discharge
SUCTIONINGSUCTIONING "STERILE TECHNIQUE" - the use of a "STERILE TECHNIQUE" - the use of a
sterile catheter and sterile gloves for sterile catheter and sterile gloves for each suctioning procedure. each suctioning procedure.
"CLEAN TECHNIQUE" - the use of a clean "CLEAN TECHNIQUE" - the use of a clean catheter and nonsterile, disposable catheter and nonsterile, disposable gloves or freshly washed, clean hands for gloves or freshly washed, clean hands for the procedure. the procedure.
““MODIFIED CLEAN TECHNIQUE" - MODIFIED CLEAN TECHNIQUE" - nonsterile gloves and sterile catheters). nonsterile gloves and sterile catheters).
SUCTIONING DEPTHSUCTIONING DEPTH
SHALLOW SUCTIONING – suctioning at the hub SHALLOW SUCTIONING – suctioning at the hub of the tracheostomy tube to remove secretions of the tracheostomy tube to remove secretions coughed up to the opening of the tracheostomy coughed up to the opening of the tracheostomy tube. tube.
The PRE-MEASURED TECHNIQUE - the catheter The PRE-MEASURED TECHNIQUE - the catheter is inserted to a pre-measured depth, with the is inserted to a pre-measured depth, with the most distal side holes just exiting the tip of the most distal side holes just exiting the tip of the tracheostomy tube. tracheostomy tube.
DEEP SUCTIONING - the insertion of the DEEP SUCTIONING - the insertion of the catheter until resistance is met, withdrawing catheter until resistance is met, withdrawing the catheter slightly before suction is applied. the catheter slightly before suction is applied.
WHEN IS SUCTIONING WHEN IS SUCTIONING REQUIRED?REQUIRED?
Whenever patient is unable to clear Whenever patient is unable to clear secretions by coughingsecretions by coughing
Bleeding down the airwayBleeding down the airway
WHEN TO SUCTION 1WHEN TO SUCTION 1
Mucus bubbling in trachy tube Mucus bubbling in trachy tube Audible gargling soundsAudible gargling sounds Laboured breathingLaboured breathing RestlessnessRestlessness Gurgles heard on auscultation Gurgles heard on auscultation Low SpOLow SpO22
WHEN T SUCTION 2WHEN T SUCTION 2 Stridor or changes in breathing Stridor or changes in breathing
Cyanosis Cyanosis
Increased ventilator inspiratory pressure Increased ventilator inspiratory pressure (for patient on ventilator, a high pressure (for patient on ventilator, a high pressure alarm may sound) alarm may sound)
Patient request Patient request
INSTILLINGINSTILLING Introduction of normal saline into the Introduction of normal saline into the
airway to aid removal of thick, tenacious airway to aid removal of thick, tenacious secretions. secretions.
TENACIOUS SECRETIONSTENACIOUS SECRETIONS Systemic hydration Systemic hydration
Humidification Humidification
Chest physiotherapy Chest physiotherapy
Suctioning, coughs and assisted coughs Suctioning, coughs and assisted coughs
Mucolytic agents Mucolytic agents
COMPLICATIONSCOMPLICATIONS
IMMEDIATEIMMEDIATE
EARLYEARLY
LATELATE
COMPLICATIONS 1COMPLICATIONS 1
IMMEDIATEIMMEDIATE
BleedingBleeding
Pneumothorax/PneumomediastinumPneumothorax/Pneumomediastinum
Injury to adjacent structuresInjury to adjacent structures
COMPLICATIONS 2COMPLICATIONS 2
EARLYEARLY
BleedingBleeding
Tube obstructionTube obstruction
Tube displacement/dislodgementTube displacement/dislodgement
Subcutaneous EmphysemaSubcutaneous Emphysema
AtelectasisAtelectasis
COMPLICATIONS 3COMPLICATIONS 3 LATELATE
BleedingBleeding
Tracheal stenosisTracheal stenosis
TracheomalaciaTracheomalacia
Tracheo-esophageal fistulaTracheo-esophageal fistula
Failure to de-cannulateFailure to de-cannulate
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