tracheostomy.pptx

tracheostomy-Dr Parvathi Jayagopal

1. Tracheostomy Dr. Parvathi Jayagopalan Dept of OMFS

2. Outline Definition Indications Procedure Types of tracheostomy tubes Tracheostomy care Complications Cricothyrotomy Percutaneous tracheostomy Decannulation

3. Definition Tracheostomy : c reation of permanent or semi permanent opening in trachea to maintain airway patency.

4. History First mentiones in Rig Veda – 2000 BC Egyptian manuscipts- 3500 yrs ago. Fabricius (1617) & Habicot (1620)- first technical descriptions. Heister (1718) – introduced term “tracheotomy” Negus (1938)- coined term “tracheostomy”

5. Types Temporary Temp or permanent Elective or emergency Permanent Laryngectomy Diversion procedure

6. INDICATIONS Impending upper airway obstruction Major laryngeal trauma Prolonged intermittent positive pressure ventilation Inability to intubate or perform cricothyrotomy Laryngeal foreign body or pathology Hypercarbia/ hypoxemia due to flail chest/ lung contusions. When IPPV- for control of cerebral edema in head injuries.

7. Indications: Mechanical Obstruction

8. Indications: contd PROTECTION of AIRWAY Neurological Diseases(Polyneuritis eg GBS, MN Diseases) Coma (GCS<8, risk of aspiration) RESPIRATORY FAILURE Pulmonary Disease Flail Chest RETENTION of SECRETIONS In acute resp. infection, pulmonary disease etc Elective Tracheostomy as Adjunct to H&N surgeries > 21 days on ETT < 14 days on ETT(relative)

9. Procedure Anaesthesia LA GA Incision Transverse Longitudinal Positioning Supine Shoulder pad Head ring

10. Procedure cont’d Skin Prep with povidine iodine, chlorohexidine ( savlon ) Draping Good light source and suction machine ready and tested to be functional

11. Procedure cont’d Blunt dissection of subcut tissue Transversely Retracted as shown

12. Procedure cont’d Transverse Incision 2-4cm below cricoid cart/ 2-4cm above suprasternal notch Incision length= anterior border of SCM msc lateral Blunt dissection of subcut

13. Procedure cont’d Strap msc is divided longitudinally at midline

14. Procedure cont’d Langerbeck retractor used to retract laterally

15. Procedure cont’d Thyroid isthmus is divided at midline by 2 haemostat and cut edge secured by 2/0 vicryl Thyroid retracted superiorly

16. Procedure cont’d Depending on the the TT size abt 4cm longitudinal opening is made to trachea below 2nd ring

17. Procedure cont’d Negus tracheal dilator applied and TT inserted in between

18. Procedure cont’d Tube is anchored

19. Pediatric Tracheostomy Vertical incision in trachea b/w 2 nd and 3 rd ring. No excision of ant. Wall of trachea Secure the tube with neck by two sutures

20. Types of Tubes Cuffed tubes Un-cuffed Fenestrated Inner cannula Adjustable flange PVC, Silver, Silicone and Rubber Mini Tracheostomies

21. Types of tubes Metallic tube

22. Fenestrated tracheal tube Allow patient to ventilate past tube via upper airway Allow speech

23. Cuffed Tubes Allows ventilation and prevents aspiration High cuff pressure can be damaging Check pilot cuff DO NOT BLOCK THIS TUBE

24. Cuffed tracheostomy tube

25. Un-cuffed Tubes Maintains airway once aspiration risk has passed Increase airflow to the larynx Which patients: Long term tracheostomy pts P atients who do not require a seal Paediatrics

26. Uncuffed tracheostomy tube

27. Neck collar

28. Cricothyrotomy or Minitracheostomy Thyroid cartilage Cricothyroid membrane Crycoid cartilage

29. 1 2 3 4 5

30. Portex minitracheostomy

31. Cricothyrotomy Convert to trach Keep only for 3-5 days Complications – Subglottic oedema Surgical emphysema Perichondritis Infection VC injury Stenosis

32. Percutaneous Tracheostomy Small skin incision – second to third rings Some blunt dissection 14 G cannula with syringe Guidewire through cannula Dilators / Dilating forceps Tracheostomy tube with obturator

33. Percutaneous Tracheostomy Contraindications Children Bleeding diathesis Previous surgery Infection Dangerous in : Short neck Thick & fat neck Enlarged thyroid / swelling

34. Complications of Tracheostomy Intraopertaive Complications Bleeding and injury to big vessels Injury to tracheoesophageal wall Pneumothorax Apnea Cardiac arrest Early Complications Bleeding Tracheostomy tube obstruction Tracheostomy tube displacement Infection

35. Late Complications Tracheal Stenosis Granulation tissue Tracheocutaneus fistula Tracheo - inominate fistula

36. PROBLEMS DURING TRACHEOSTOMY CARE Dislocation of tracheostomy tube Bleeding from stoma or during suction Blockage of tracheostomy tube Aspiration and swallowing problems Speaking problems Decannulation problems

37. DECANNULATION Stepwise Uncuff , Downsizing if neccessary Airtight dressing