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Tracheostomy

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Upper and Lower Respiratory System

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What is a tracheotomy?

its involves surgical creation of an externalopening through the 2nd and 3rd or 3rd and 4th

ring of the trachea

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A Tracheostomy can be

- Temporary,- Permanent or

- placed during Emergency.

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Cricothyrotomy

is an emergency tracheotomy that mayalso be performed when endotracheal

intubation is impossible

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Indications for Tracheostomy :1. Airway Obstruction

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Congenital

Ex: larynx hemangioma Ex: Sub glottic or tracheal

stenosis,

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Foreign body aspiration

Ex: Swallowed or inhaledobject lodged in upper airway

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Infection

Ex: Acute epiglottitis,

It is an infection of the

epiglottis and

supraglottic

structures.

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3.Long Term Intubation:

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Long TermWhat is consideredIntubation for an adult and pediatric

patient???

Adult: Intubated more than two weeks.

Pediatric: Intubatedmore than 3-4 weeks.

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4. Elective/Prophylactic

1- During major head and neck surgery

2- Radiation treatment

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What physiological changes occur

with a tracheostomy???

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IN 2 WAYS :1-SURGICAL {OPEN (ST)}(ENT) SURGEON, OR A THORACIC SURGEON.

2- PERCUTANEOUSPERCUTANEOUS DILATATION

TRACHEOSTOMY (PDT) IS DONE USING PERCUTANEOUS DILATATION

TECHNIQUE.

How is a Tracheostomy performed?

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Surgical tracheostomy performed in

patients with:

1. Tumors of the upper airway

2. Previously failed/difficult percutaneous procedure3. Major vascular structures at risk

4. Anatomical abnormality (e.g. goiters)

5. Short neck

6. Morbid obesity7. Emergency airway

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Goitersis a swelling of the thyroid gland, which can lead to a swelling of the neck or larynx (voice box)

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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 theinsertion, while the stoma is forming oras

ordered by the operating surgeon.

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Percutaneous

insertion:

The first tube change shouldnot be performed before 2

weeks of the initial insertion??

because the stoma is very tight

and the risk of the tracheotomy

collapsing is high.

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Holistic Nursing Considerations

During the first 2-3 daysthe patient is

uncomfortable due totrauma of surgery, pain of a fresh incision,

choking, presence of a foreign object in his

trachea and inability to communicate throughspeech.

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keep in mind .. the

patient is more than a

trach tube!

1- pain management.

2- reassurance.

3- education

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What are the risks involved in

tracheostomy?

1-Reactions to medication andanesthesia.

2-Uncontrollable bleeding.

3-Respiratory problems.4-Possibility of cardiac arrest.

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What are the complications of a

Tracheostomy?

Early ( Life-threatening ) Late

Infection :

1- stoma site

2- chest-

50-60% of tracheostomy patients maydevelop 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

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What are the parts of the

tracheostomy tube?

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Parts of Tracheostomy Tube

Main featuresPart

Main body of the tubeOuter canula

A balloon at the distal end of the tube, provide

seal between the rachea & tube

cuff

External balloon connected to the inflation line tothe internal cuff ( vice versa)

Pilot balloon

Support the main tube structure.

Tube type, size & coude

Flange/ neck plate

Bevel, smooth rounded dilating tip tipped placedinside 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

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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.

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Cuffed t.t

contraindicationindication

Child < 12 years oldRisk of aspiration

Risk of tracheal tissue damage from cuffNewly formed stoma ( adult )

PPV

Unstable condition

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Indication

cufflesscuff

No risk for aspirationMinemiz aspiration

Pt no longer need PPVAllow PPV ( one way valve )

Pt still need airway accessClose system ( upper & lower airway )

Minemiz emphysema

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Indication Close Suction System:

- Pt regyuireing Highy PEEP, Fio2

- TB, ARDS

- To Avoiding dramatic drop in oxygen.

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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 )

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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, humidificationmethod.

S ti i

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Suctioning

Indications for Suctioningif pt have one or more of the following :

Excessive secretions

Decreased oxygen saturations

Tachypnea , bradypnea or tachycardia

Restlessness, increased use of intercostalmuscles, 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

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Prior to section:

- hyperventelation- hyperoxygenation

to Reduse Hypoxemia.

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Famous People who was

tracheostomies

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King Fahd bin Abdul Aziz Al Saud(king of SA)

John Fitzgerald Kennedy (U.S. President)

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Thank you

done by :

Marwah M.Ibrahim

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Any Question

:References

- American Journal of Critical Care.

- Tracheostomy multiprofessional handbook (1edaddition ).

- Critical Care Nurse.

-http://www.aurorahealthcare.org/yourhealth/health

gate/getcontent.asp?URLhealthgate=%2214874.html%22