TRACHEOSTOMY

&
TRACHEOSTOMY
CARE
 CLASS/BATCH :
2ND YR GNM
HINE

PREPARED BY:
Ms. Chanda Das
LECTURER, MSN DEPT
HINE
The tracheostomy tube is inserted into the windpipe (trachea).
Breathing occurs through this opening.
INTRODUCTION
What is tracheostomy?
A tracheostomy is an artificial opening or hole at the front of
neck into the windpipe (trachea), usually between the third and
fourth rings of cartilage. This opening is called a stoma. It allows
air to go in and out of the lungs.
Size :
Male -11mm in diameter
Female - 10mm in diameter
Neonates - 30-36 mm in diameter
Infant - 39- 50 mm in diameter
 INDICATION
1. To relieve upper airway obstruction
Foreign body
Trauma
Acute infection – acute epiglottis, diphtheria
Tumors of the larynx
Glottic edema
Congenital web or atresia
2. To clean and remove secretions from the airway
3. Long term need for ventilator support.
2. To improve respiratory function
Fulminating bronchopneumonia
Chronic bronchitis, emphysema
Chest injury, flail chest

3. Respiratory paralysis
Unconscious head injury
Bulbar poliomyelitis
Tetanus
 TYPES
1. Temporary tracheostomy
2. Permanent tracheostomy

1.Temporary tracheostomy:
A temporary tracheostomy can be formed when patients
require long term respiratory support or unable to protect their
own airways. A tracheostomy tube will be inserted to maintain the
patency their own airways. This can be removed when the patient
recovers. It may become long term if the patients condition
requires this.
2. Permanent tracheostomy:
The trachea is permanently disconnected from the
pharynx, and the proximal
end of the trachea is sutured
to the skin of the neck wall.
Used for longer period of
time. As a result, there is no
connection between the nasal
passages and the trachea.
Metal tracheostomy Plastic tracheostomy
 Parts of tracheostomy
Tubes are made of metal or synthetic materials. A commonly used
tracheostomy tube consists of three parts :
outer cannula with flange (neck plate),
inner cannula and;
obturator
1. Outer cannula – it is the outer tube that holds the
tracheostomy open.

2. Inner cannula – it fits inside the outer cannula. It has a lock to

keep it from being coughed out, and is removed for cleaning.

3. Obturator – is used to insert a tracheostomy tube. It fits inside

the tube to provide a smooth surface that guides the tracheostomy
tube when it is being inserted.
Cuff - the “balloon” on the end of the tracheostomy tube. When
inflated, it forms a seal against the wall of the windpipe.

Inflation line - thin plastic tubing that carries air to and from
the cuff.

Side port/Balloon - a small, plastic balloon like component on

the end of the inflation line. The cuff port shows if the cuff is
inflated. It is also called a pilot balloon.
Flange – a neck plate extends from the sides of the outer tube
and has holes on either side to attach neck ties or Velcro strap
around the neck.

15mm connector - part of the tracheostomy tube or inner

cannula that sticks out at the neck. Ventilator tubing, a manual
resuscitation bag, or a speaking valve may be connected to the
15mm connector.
 Procedure
Before performing a tracheostomy the site of obstruction should
be determined.
The pt is made to lie down on their back or supine position with
the neck and head extended by
keeping a pillow or sandbag under
the shoulder and neck or scapula.
Local anesthesia and general
anesthesia is used for the procedure.
The incision is made over the second tracheal ring below the
larynx. The incision may be made
from side to side or up and down.
The underlying small muscles in
front of the trachea are spread to
the side.
Sometimes the isthmus (thin middle
portion) of the thyroid may have to be cut to expose the second
tracheal ring.
Once the trachea is exposed, an incision is made through the
second & third tracheal cartilage rings by placing a cricoid hook.
Before the tracheostomy tube is introduced, the trachea is
suctioned thoroughly to remove the secretions & blood.
A suitable size tracheostomy tube is introduced inside using
obturator. The tube should be three fourth of the diameter of the
trachea.
The cuff of the tube has a balloon at its end is inflated by using
2-5 ml of air and is held in place by using a necktie.
The tube from the breathing machine or oxygen tube is
connected to the tracheostomy tube.
Sutures are used to close the skin incision by the side of the
tracheostomy tube and a tape is tied around the neck to secure
the tube.
 Care after surgery
1. Maintain patency of tracheostomy tube and airway
Frequent atraumatic suction
Humidification of inspired air and oxygen
Fowler’s position to aid in breathing
Maintain adequate fluid intake
Provide frequent mouthwash
Mucolytic agents
Coughing & Physiotherapy
2. Prevent infection and complications
Aseptic tube section, handling and tube changing
Prophylactic antibiotics
Deflate cuff for 5 mins every hours
 Complications
Hemorrhage
Pneumothorax (air trapped around lungs)
Esophageal surgical trauma
Recurrent laryngeal nerve
Tracheal erosion
Tube displacement & obstruction
Subcutaneous emphysema
Aspiration of secretion
Lung abscess
Laryngeal & tracheal stenosis
Tracheo-oesophageal fistula
Advantages
Reduces patient discomfort
Reduces need for sedation
Improves ability to maintain oral and bronchial hygiene
Reduces risk of trauma to the windpipe and trachea
Makes breathing easier
THANK YOU