TRACHEOSTOMY

DR. A. NAVEED
FRCS (Ed) ENT Department Tawam Hospital Al-Ain, Abu Dhabi U.A.E.

Tracheotomy
operative procedure that creates an artificial opening in the trachea.

Tracheostomy creation of permanent or semi

permanent opening in trachea.

Anatomy
Trachea lies in midline of the neck extending from cricoid cartilage (C6) superiorly to the tracheal bifurcation at the level of sternal angle (T5). Comprises 16-20 C shaped cartilage rings. Length 10-12cm. Diameter 15-20mm.

Indications
1. Upper Airway Obstruction. 2. Pulmonary Ventilation. 3. Pulmonary Toilet. 4. Elective Procedure

1. Upper Airway Obstruction

a. b. c. d.

Trauma Foreign body Infections Malignant lesions

2. Pulmonary Ventilation
Tracheostomy should be performed in a patient still requiring ventilation through an endotracheal tube for more than a one week.

3. Pulmonary Toilet
Those who cannot cough and clear their chest. Prevent aspiration by low pressure high volume cuff tracheostomy tube.

4. Elective Procedures For major head and neck operations.

Elective Tracheostomy
Anaesthesia: G A Position: Supine with sand bag under the shoulder Incision:horizontal incision b/w cricoid cartilage and suprasternal notch. Division /retraction of thyroid isthmus Opening of Trachea and insertion of tube

Emergency Tracheostomy
Within 2-4 mints with vertical incision

Cricothyrotomy/mini tracheostomy
Transverse incision over the cricothyroid membrane. Keep only for 3-5 days

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

Percutaneus Dilational Tracheostomy

ICU Bed SideTracheostomy Use of guide wire and Dilators Under the vision of Bronchoscope through endotracheal tube Less time ,Less Expensive Not suitable for thick neck and in emergency

Complications of Tracheostomy Intraopertaive Complications.

Bleeding and injury to big vessels Injury to tracheoesophageal wall Pneumothorex

Early Complications
Bleeding Tracheostomy tube obstruction Tracheostomy tube displacement Infection

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

PROBLEMS DURING TRACHEOSTOMY CARE

1. 2. 3. 4. 5.

Dislocation of tracheostomy tube. Bleeding from stoma or during suction. Blockage of tracheostomy tube. Aspiration and swallowing problems. Speaking problems.

HOME CARE PLAN

1. 2. 3. 4.

Education and training of the attendant. Supply of dressing, suction catheters and suction machine. When to come to the hospital. Visit by community nurse.