Tracheostomy

1

Anatomy:

·         Adult trachea is 11.8 cms in length from infra cricoid level to the carinal spur

·         Cartilaginous rings 18 – 20

·         Average 2 rings per cm

·         Diameter 2-3 cms laterally 1.8 cms AP, elliptical in cross-section in adults and circular in infants and children’s

·         Rings are incomplete

Indications

1.        Infant and chiderns

Severe respirator/cardiac diseases which requires prolong ventilation (several months)

2.        Chest trauma

Unstable chest wall, lung damage, head injury.

3.    Pulmonary insufficiency

Poor PFT + chest infection in elderly people

4.    Neurological problem

Head injury, CVA, Bulbar palsy, GBS, poliovirus

5.          Laryngeal and Hypopharyngeal disease (malignant disease of larynx     and Hypopharynx

Surgical Technique

·         GA

·         Position supine

·         Sand bags under shoulder, neck extended

·         Transverse incision 2.5 cms above the suprasternal notch and 5 cms in length dividing skin subcutaneous tissue platysma pretracheal fascia and strap muscle separated

·         Thyroid isthmus retracted or divided

·         Longitudinal incision given in trachea in midline through 2^nd 3^rd and 4^th Tracheal rings

·         Tracheal opening is held apart and appropriate size tracheostomy tube is inserted and fixed with stitches and tape

·         Tube can be changed safely after 48 hours

Care of Tracheostomy

There are some disadvantages of tracheostomy

1.        Increased risk of local & pulmonary infection

2.        decreased ability of patient to clear secretion

3.        inadequate humidfication of air

4.        inability to communicate

So this procedure should be done when there is absolute indication and must be done by sterile technique

·         Appropriate care of tracheostomy wound

·         Staff handling the patient should avoid contacts with other patients

·         Must be appropriate humidification

Care of tracheostomy Cuff

1.        Tube must be of inert ,smooth material PVC

2.        Never over inflate, never under inflate

3.        Must be deflated after few hours for couple of minutes

Complications

·         Haemorrhage,

·         Incorrect placement,

·         Injury to adjacent structures

·         Hypoxia during procedure

·         Plugging of tube during insertion

Early complications

1.        haemorrhage /haematoma

2.        displacement

3.        herniation of cuff

4.        infection

Intermediate complication

1.        infection

2.        tracheoinnominate artery fistula

3.        tracheo oesophageal fistula

Late complications

1. tracheal stricture

2. failure of closure

Types of traecheostomy

·         Cervical Traechostomy open method

·         Percutaneous tracheostomy

·         Mini tracheostomy

·         Mediastinal Tracheostomy

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