Trachy

� Tracheostomy

1. Tracheostomy

2. Upper and Lower Respiratory System

3. What is a tracheotomy? it’s involves surgical creation of an external opening through the 2 nd and 3 rd or 3 rd and 4 th ring of the trachea

4. A Tracheostomy can be - Temporary, - Permanent or - placed during Emergency.

5. Cricothyrotomy is an emergency tracheotomy that may also be performed when endotracheal intubation is impossible

6. Indications for Tracheostomy : 1. Airway Obstruction

7. Congenital Ex: larynx hemangioma Ex: Sub glottic or tracheal stenosis ,

8. Foreign body aspiration Ex: Swallowed or inhaled object lodged in upper airway

9. Infection Ex: Acute epiglottitis , It is an infection of the epiglottis and supraglottic structures .

10. 2. Airway Clearance: clears the secretions that cannot be cleared due to weakness and conditions requiring long term airway support, like progressive neurological conditions such as: Severe brain injury …. ect

11. 3.Long Term Intubation:

12. What is considered Long Term Intubation for an adult and pediatric patient??? Adult: Intubated more than two weeks. Pediatric: Intubated more than 3-4 weeks.

13. 4. Elective/Prophylactic 1- During major head and neck surgery 2- Radiation treatment

14. What physiological changes occur with a tracheostomy ???

15. temporary voice loss. loss of the airborne particle filtration, warming and humidification action of the nose . potential impairment of swallowing. Mucociliary transport and cough mechanisms are impaired.

16. in 2 ways : 1-Surgical {open (ST)} (ENT) surgeon, or a thoracic surgeon. 2- Percutaneous Percutaneous dilatation tracheostomy (PDT) is done using percutaneous dilatation technique . How is a Tracheostomy performed?

17. Surgical tracheostomy performed in patients with: 1. Tumors of the upper airway 2. Previously failed/difficult percutaneous procedure 3. Major vascular structures at risk 4. Anatomical abnormality (e.g. goiters) 5. Short neck 6. Morbid obesity 7. Emergency airway

18. Goiters is a swelling of the thyroid gland, which can lead to a swelling of the neck or larynx (voice box)

19. Nursing Considerations In (ST), the pt may come back with stay sutures around the tube - to hold or manipulate the operating area. In ST sutures are removed after the first tracheostomy tube change - 5-7 days of the insertion, while the stoma is forming or as ordered by the operating surgeon.

20. stay sutures done: to prevint accedint accidentally dislodged.

21. Percutaneous insertion: The first tube change should not be performed before 2 weeks of the initial insertion?? because the stoma is very tight and the risk of the tracheotomy collapsing is high.

22. Holistic Nursing Considerations During the first 2-3 days…the patient is uncomfortable due to trauma of surgery, pain of a fresh incision, choking, presence of a foreign object in his trachea and inability to communicate through speech .

23. keep in mind .. the patient is more than a “ trach tube!” 1- pain management. 2- reassurance. 3- education

24. What are the risks involved in tracheostomy ? 1-Reactions to medication and anesthesia. 2-Uncontrollable bleeding. 3-Respiratory problems. 4-Possibility of cardiac arrest.

25. What are the complications of a Tracheostomy ? Early ( Life-threatening ) Late Infection : 1- stoma site 2- chest- 50-60% of tracheostomy patients may develop nosocomial pneumonia Skin breakdown Tracheal stenosis Tracheo -esophageal fistula : 1- Abdominal distention 2- Liquid food suctioned through tracheostomy tube. Accidental tube displacement Blocked tracheostomy tube Damage during surgery - possible hemorrhage . Sx emphysema Trauma Pneumothorax

26. What are the parts of the tracheostomy tube?

27. Parts of Tracheostomy Tube Main features Part Main body of the tube Outer canula A balloon at the distal end of the tube, provide seal between the rachea & tube cuff External balloon connected to the inflation line to the internal cuff ( vice versa) Pilot balloon Support the main tube structure. Tube type, size & coude Flange/ neck plate Bevel, smooth rounded dilating tip tipped placed inside the inner canula of the tube during insertion . ( reduce the risk of trauma ) removed once the tube in correct placement Introducer/ obturator Allow attachment to ventilation equipment/ ambu -bag 15 mm adaptor

28. Types of tracheostomy tubes Single lumen: - Larger inner diameter than double lumen tube. - Absence of removable inner cannula . Double lumen: - Removable inner cannula (twist-lock connection ) prevent build up of secretion.

29. Cuffed t.t contraindication indication Child < 12 years old Risk of aspiration Risk of tracheal tissue damage from cuff Newly formed stoma ( adult ) PPV Unstable condition

30. Indication cuffless cuff No risk for aspiration Minemiz aspiration Pt no longer need PPV Allow PPV ( one way valve ) Pt still need airway access Close system ( upper & lower airway ) Minemiz emphysema

31. Indication Close Suction System: - Pt regyuireing Highy PEEP, Fio2 - TB, ARDS - To Avoiding dramatic drop in oxygen.

32. Fenestration: Single or multiple holes in the superior curvature of the shaft of outer and inner cannula . Indication: - Improve speech & swallowing function .

33. Occlusion cap: Soolid piece of plasticc can be placed on the end of a 15mm hub. Indication : Blocks all air flow via tracheostomy (end stage weaning )

34. Humidification: 1- pt requiring oxygen with excessive secretion/bedridden ( continuous \ ATM ) with need to be labeled, dated and changed as per PP. 2- alert mobiles pt with minimal secretion ( HME ) change Q 24hr. 3- buchannan bib ( contains a special foam ( hydrolox ) which act as filter & HME. Shoud by Change/washed up to 3 use’s only.

35. Nursing Considerations..

36. Condition of tracheostomy dressing wet/dry Stoma site should be observed for: - Bleeding - Increase stoma size - Appearance of stoma edges and tissue ( e.g. maceration, cellulites) - Evidence of infection (purulent discharge, pain, offensive odor, tenderness - Allergic reaction to dressing product - Tube secured to skin, ties are appropriately tight Patient on oxygen: TM T-piece, humidification method.

37. Suctioning Indications for Suctioning if pt have one or more of the following : Excessive secretions Decreased oxygen saturations Tachypnea , bradypnea or tachycardia Restlessness, increased use of intercostal muscles, or sweating Noisy breath sounds/decreased breath sound Poor ineffective cough Change in skin color from baseline Reduced expired air flow from tube during expiration Collection of sputum specimens

38. Prior to section: - hyperventelation - hyperoxygenation to Reduse Hypoxemia.

39. Caution: COPD: patients should only have 20% increase of oxygenation. Hyperventelation , will be used for non-spontaneous breather, as it may have significant adverse effects . Ex: Reduced venous return and barotraumas

40. Potential Complications of Suctioning: - Hypoxemia - Hypotension - Increased intracranial pressure - Hyper/Hypoventilation - Cardiac arrhythmias - Increased work of breathing - Bronchospasm - Infection - Accidental extubation / decannulation - Cardiac Arrest

41. Famous People who was tracheostomies

42. King Fahd bin Abdul Aziz Al Saud (king of SA) John Fitzgerald Kennedy (U.S. President)

43. Thank you done by : Marwah M.Ibrahim

44. ؟؟؟ Any Question : References - American Journal of Critical Care. - Tracheostomy multiprofessional handbook (1ed addition ). - Critical Care Nurse. http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%2214874.html%22