TRACHEOSTOMY

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TRACHEOSTOMY

• Miss H.Babar-Craig

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Indications for a Tracheostomy

• 1 . AIRWAY OBSTRUCTION
• Congenital - subglottic stenosis, webs, cysts
• Trauma - foreign bodies, burns, corrosive
• Infection epiglottitis, Ludwigs angina, croup
• Tumour tongue, larynx, pharynx, thyroid
• Vocal Cord Paralysis

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Indications for Tracheostomy

• 2. PROTECTION OF AIRWAY
• Neurological diseases bulbar palsy, MS, MG
• Trauma burns, facial fractures
• Coma head injury, CVA, overdose
• Head Neck surgery
• 3. VENTILATORY SUPPORT
• Usually day10 on ITU
• Excessive airway secretions

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Surgical Tracheostomy

• Chevalier Jackson 1909
• Horizontal incision midway between sternal notch
  and cricoid cartilage ( 2 fingerbreadths above
  sternal notch). Through skin, subcutaneous tissue
  and platysma.
• Midline Vertical incision to separate
  sternohyoid, sternothyroid to reveal thyroid
  isthmus. This is suture ligated to reveal
  trachea.
• 1 cm2 Section of 2rd or 3th tracheal ring removed.

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Complications

• 1. Hemorrhage, pneumothorax, surgical emphysaema,
  recurrent laryngeal nerve damage.
• 2. Tube displacement
• 3. Tube obstruction mucous plug
• 4. Long term - Tracheal stenosis ( mucosal
  ischaemia due to over inflation of balloon),
  tracheo-innominate fistula, tracheocutaneous
  fistula.

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Tracheostomy Site
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Tracheostomy Tubes

• CUFFED TUBE
• For protection of airway from aspiration or
  hemorrhage
• INNER TUBES
• Facilitates cleaning and removal of crusted
  secretions
• FENESTRATED TUBES
• Allows air to flow up to glottis speech

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Tracheostomy
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Tracheostomy Tubes

• SYNTHETIC TUBES
• Most are made from PVC, silicone, plastic
• Two main types 1. SHILEY
• 2. PORTEX
• They have low pressure cuffs
• CHILDREN do NOT have cuffed tubes due to tracheal
  necrosis- subglottic stenosis

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Tracheostomy Tubes

• SIZES size10 4 ( more plugging small tubes)
• ADJUSTABLE FLANGES for people with long
  distance from skin to trachea.
• TRACHEAL BUTTON for weaning off tracheostomy,
  protocol for weaning.
• One way speaking valves valve opens during
  inspiration on superior curve of tube
• Humidification Swedish nose, to prevent crusting

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Tracheostomy Tubes

• PERMANENT TUBES
• Metal ( Silver) Tubes -
• Chevalier Jackson and Negus
• They have fenestrations and inner tubes.
• Easier to clean.

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Tracheostomy Tubes

• PROBLEMS
• 1. Infection
• 2. Mucous plugging
• 3. Require humidification
• 4. Regular suctioning
• 5. Swallowing problems due to indenting of
• oesophagus