TRACHEOSTOMY &

CRICOTHYROIDOTOMY
AYMAN YAKOUT
GMU AJMAN UAE

INTRODUCTION

Tracheostomy is an operative
procedure that creates a surgical
airway in the cervical trachea

It is considered synonymous with

tracheotomy

LARYNX & TRACHEA

ANATOMY I

ANATOMY II

ANATOMY III

ANATOMY IV

UPPER AIRWAY OBSTRUCTION

-RECOGNITION

Dyspnea
Stridor
Voice change
Decreased or absent breath sounds
Restlessness
Hemodynamic instability (late)
Loss of consciousness (very late)

INDICATIONS FOR
TRACHEOSTOMY

To bypass obstruction
Long-term Mechanical ventilation
Pulmonary toiletting
Neck trauma
Tumor
Bilateral vocal cord paralysis
Laryngeal Edema
Respiratory failure

FORMS OF TRACHEOSTOMY

Emergency tracheostomy

Urgent tracheostomy

Elective tracheostomy

INTRAOPERATIVE DETAILS:
TRACHEOSTOMY

TRACHEOSTOMY

TRACHY TUBES

TUBE PARTS

METALIC TUBES

PLASTIC TUBES

USE OF FENESTRATED TUBE

Chest X-ray
after trachy

POSTOPERATIVE DETAILS

Postoperative care is critical.

Copious secretions is the norm

Suctioning every 15 minutes may be

required

Suctioning should be shallow initially

Suctioning should be limited to no more

than 15 seconds

POSTOPERATIVE DETAILS 2

Humidified oxygen helps prevent

inspissation of the secretions.

Mucolytic agents may be employed.

If uncorrected, mucus plugging of the

inner cannula can cause a life-threatening
obstruction.

POSTOPERATIVE DETAILS 3

The original tube is left sutured in place

for 5-7 days to allow the tract to heal.

Then the sutures are removed, and the

tube is replaced.

The site should be kept clean and dry to

minimize infection

Patient and family education should begin

ASAP

FOLLOW-UP CARE

Speaking: should be encouraged when

cuff is deflated

Swallowing: Swallowing is more difficult

Evaluate risk of aspiration before feeding

Educate: both patient and family

Equipment: for discharge

SUCTIONING

"STERILE TECHNIQUE" - the use of a

sterile catheter and sterile gloves for
each suctioning procedure.

"CLEAN TECHNIQUE" - the use of a clean

catheter and nonsterile, disposable
gloves or freshly washed, clean hands for
the procedure.

MODIFIED CLEAN TECHNIQUE" nonsterile gloves and sterile catheters).

SUCTIONING DEPTH

SHALLOW SUCTIONING suctioning at the hub

of the tracheostomy tube to remove secretions
coughed up to the opening of the tracheostomy
tube.

The PRE-MEASURED TECHNIQUE - the catheter

is inserted to a pre-measured depth, with the
most distal side holes just exiting the tip of the
tracheostomy tube.

DEEP SUCTIONING - the insertion of the

catheter until resistance is met, withdrawing
the catheter slightly before suction is applied.

WHEN IS SUCTIONING
REQUIRED?

Whenever patient is unable to clear

secretions by coughing

Bleeding down the airway

WHEN TO SUCTION 1

Mucus bubbling in trachy tube

Audible gargling sounds
Laboured breathing
Restlessness
Gurgles heard on auscultation
Low SpO2

WHEN T SUCTION 2

Stridor or changes in breathing

Cyanosis

Increased ventilator inspiratory pressure

(for patient on ventilator, a high pressure
alarm may sound)

Patient request

INSTILLING

Introduction of normal saline into the

airway to aid removal of thick, tenacious
secretions.
TENACIOUS SECRETIONS

Systemic hydration
Humidification

Chest physiotherapy

Suctioning, coughs and assisted coughs

Mucolytic agents

COMPLICATIONS

IMMEDIATE

EARLY

LATE

COMPLICATIONS 1

IMMEDIATE

Bleeding

Pneumothorax/Pneumomediastinum

Injury to adjacent structures

COMPLICATIONS 2

EARLY

Bleeding

Tube obstruction

Tube displacement/dislodgement

Subcutaneous Emphysema

Atelectasis

COMPLICATIONS 3

LATE

Bleeding

Tracheal stenosis

Tracheomalacia

Tracheo-esophageal fistula

Failure to de-cannulate