Why and How Tracheostomy done?

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                         TRACHEOSTOMY

INTRODUCTION:

  • Tracheostomy is making an opening in anterior wall of trachea and covering it into stoma on skin surface
  • Types: 
Emergency tracheostomy,

Elective tracheostomy

Permanent tracheostomy

  • Mid tracheostomy ideal, commonly used through 2nd and 3rd rings behind isthmus
  • Tracheostomy tubes are made of plastic ,soft ,least irritant and disposable 
  • They have inflatable cuff, should be deflated at regular interval to prevent -tracheal necrosis due to pressure





FUNCTIONS:

  • Respiration through alternative pathway in case of obstruction above the stoma
  • Protection of airway from: aspiration of pharyngeal secretion in comatose patient 
  • Blood due to injuries in pharynx ,larynx





INDICATION:

  • RESPIRATORY OBSTRUCTION:

Infection- Ludwig angina,

Peritonsillar infection

Tumor

Trauma to larynx, trachea

  • RETAINED SECRETION:

(Inability to cough)

Comatose patient

Painful cough -trauma to chest

  • RESPIRATORY INSUFFICIENCY:

Chronic lung conditions:

Emphyema

bronchiectasis





TECHNIQUE:

  • Children is intubated prior to surgery 







Position:

  • Supine with neck extended under local or general anesthesia
  • Incision can be vertical (emergency case),transverse (elective case)
  • Veins on the surface ligated -strap muscle separated in midline-thyroid gland retracted upward with blunt hook
  • Trachea exposed -4% xylocaine is infiltrated into trachea 

TRANSVERSE INCISION:

  • Between second and third tracheal ring ,two ends joined with another transverse incision
  • Appropriate size tracheostomy tube is placed ,cuff inflated 
  • Children, vertical or h incision is made





COMPLICATION:

  • EARLY:

Bleeding, wrong placement of tracheostomy tube

  • INTERMEDIATE:

Secondary infection of wound ,blockage of the tube

  • LATE :

Scar 

Tracheal stenosis

CARE :

  • Supervision for bleeding ,breathing difficulty 
  • Suctioning :regularly every half an hourly
  • Deflate cuff every hour for 5 minutes 
  • Cleaning of tracheostomy tube 




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