Tracheotomy

”What is“Tracheotomy

• The word “tracheotomy” is derived

from the Latin “trachea” and
“tomein” (to make an opening).
• Tracheostomy is an operative
procedure that creates a surgical
airway in the cervical trachea .
 Tracheotomy
Relative anatomy
INDICATIONS:
 Edema from trauma
 Burns
 Tumors (of oropharynx, larynx, upper trachea)
 Infections (epiglottitis, severe tracheobronchitis)
 Need for prolonged respiratory support
INDICATIONS:
 Edema (tongue, laryngopharynx)
 Intubation failure
 Foreign body obstruction
 Facial fractures
 Neuromuscular diseases paralyzing or
weakening chest muscles and diaphragm
 CONTD:
 Congenital abnormalities
 Obstructive Sleep Apnea Syndrome
 Cervical spinal cord injuries with
respiratory muscles paralysis
Techniques for inserting

Surgical
tracheostomy

Percutaneous
tracheostomy
Surgical tracheostomy:

 This technique is usually carried out in an

operating theatre where conditions are sterile
and lighting is good. General anesthesia is
generally used however this technique can
also be carried out with a local anesthetics
 CONTD:
 A surgical opening is made into the trachea
into which a tube is placed; this may then be
sutured to the skin or secured with cloth ties
or a holder
Percutaneous tracheostomy

 This is the most commonly used technique in

critical care as it is simple and quick, can be
performed at the bedside using anaesthetic
sedation and local anaesthetic, and therefore
is often the technique of choice in the
critically ill
Contd:
 The procedure involves the insertion of a
needle through the neck into the trachea
followed by a guide-wire through the needle.
The needle is removed and the tract made
gradually larger by inserting a series of
progressively larger dilators over the wire
until the stoma is large enough to fit a
suitable tube (Seldinger technique). This is
then secured by cloth ties or a holder
TRACHEOSTOMY CARE
Purpose of Tracheostomy care

 Maintain airway patency by removing mucus

and encrusted secretions
 Promote cleanliness and prevent infection
and skin breakdown at stoma site
ASSESSMENT:
 Assess for excess peristomal secretions,
excess intra-tracheal secretions, or soiled
tracheostomy dressing and ties
 Assess respiratory status
 Identify factors
ASSESSMENT:
 Identify type of tracheostomy tube used and if
inner cannula is present. Identify if
tracheostomy tube is cuffed and if the cuff is
inflated
 Assess client's ability to understand and
perform independent tracheostomy care
Advantages
 Best tolerated for a prolonged period
 Easy to suction
 Easy to stabilize
 Ability to swallow
 No laryngeal injury
 Decrease dead space in the respiratory
system
 
Disadvantages:
 Infection
 Surgical procedure
 A scar will remain visible on the neck
(after removal of the tranchea canula)
 Increase risk of mucus plug
 May cause hemorrhage
 
Equipment

 Sterile towel
 Sterile gauze pads (10)
 Sterile cotton swabs
 Sterile gloves
 Hydrogen peroxide
 Sterile water
 Antiseptic solution and ointment (optional)
 Tracheostomy tie tapes or commercially
available tracheostomy securing device
 Face shield
 CONTD:
 B.P handle with blade
 Sharp scissors
 Sinus forceps
 Blunt dissector
 Tracheal dilator
 Suturing needle and suturing material
 Dissecting forceps
 Needle holder
 CONTD:
 Mackintosh and towel
 Local anesthesia
 Kidney tray and paper bag
 Spot light
 Electric suction
 Apron
`
SIZES OF TUBE:
 Inn infants: 2.5-3.5 mm
 In children: 4-4.5 mm
 In adults: 7-8.5 mm
Procedure:

Preparatory Performanc Follow-up

phase e phase phase
Preparatory phase:

 Assess the condition

 Examine the neck for subcutaneous

emphysema
Performance phase:

 Suction the trachea and pharynx thoroughly

before tracheostomy care
 Explain the procedure
 Wash hands thoroughly
 Place the sterile equipment
 contd:
 Place sterile towel on patient's chest under
tracheostomy site
 Open 4 gauze pads and pour hydrogen
peroxide on them & clean the areas
 Place tracheostomy tube tapes on field
 Put on face shield and sterile gloves
 CONTD:
 Unlock and remove inner cannula, if present
 If disposable inner cannula is used, replace
with new cannula (with your clean hand),
touching only external portion, and lock it
 If inner cannula is reusable, remove it with
your contaminated hand and clean it in
hydrogen peroxide solution, using brush or
pipe cleaners with your sterile hand
 CONTD:
 When clean, drop it into sterile saline solution
and it to rinse thoroughly with your sterile
hand. Tap it gently to dry it and replace it with
your sterile hand
   A thin layer of antibiotic ointment may be
applied to the stoma with a cotton swab
 
 CONTD:
 Change the tracheostomy tie tapes:
Follow-up phase:
 Document procedure performance
 Clean the fresh stoma every 8 hours or more
frequently
COMPLICATIONS:
 infection of the skin, trachea or lungs
 Prolonged use of a tracheostomy tube may
cause stenosis (narrowing) of the trachea
 Pneumothorax
 Tube may come out
 Tracheoesophageal fistula
 Poor laryngeal function
summarization