TRACHEOSTOMY Miss H.Babar-Craig

Indications for a Tracheostomy 1 . AIRWAY OBSTRUCTION: Congenital - subglottic stenosis, webs, cysts Trauma - foreign bodies, burns, corrosive Infection – epiglottitis, Ludwig’s angina, croup Tumour – tongue, larynx, pharynx, thyroid Vocal Cord Paralysis

Indications for Tracheostomy 2. PROTECTION OF AIRWAY : Neurological diseases – bulbar palsy, MS, MG Trauma – burns, facial fractures Coma – head injury, CVA, overdose Head & Neck surgery 3. VENTILATORY SUPPORT Usually day10 on ITU Excessive airway secretions

Surgical Tracheostomy Chevalier Jackson 1909 Horizontal incision midway between sternal notch and cricoid cartilage ( 2 fingerbreadths above sternal notch). Through skin, subcutaneous tissue and platysma. Midline Vertical incision to separate sternohyoid, sternothyroid to reveal thyroid isthmus. This is suture ligated to reveal trachea. 1 cm2 Section of 2rd or 3th tracheal ring removed.

Complications 1. Hemorrhage, pneumothorax, surgical emphysaema, recurrent laryngeal nerve damage. 2. Tube displacement 3. Tube obstruction – mucous plug 4. Long term - Tracheal stenosis ( mucosal ischaemia due to over inflation of balloon), tracheo-innominate fistula, tracheocutaneous fistula.

Tracheostomy Site

Tracheostomy Tubes CUFFED TUBE For protection of airway from aspiration or hemorrhage INNER TUBES Facilitates cleaning and removal of crusted secretions FENESTRATED TUBES Allows air to flow up to glottis – speech

Tracheostomy

Tracheostomy Tubes SYNTHETIC TUBES Most are made from PVC, silicone, plastic Two main types 1. SHILEY 2. PORTEX They have low pressure cuffs CHILDREN do NOT have cuffed tubes due to tracheal necrosis- subglottic stenosis

Tracheostomy Tubes SIZES size10 – 4 ( more plugging small tubes) ADJUSTABLE FLANGES : for people with long distance from skin to trachea. TRACHEAL BUTTON : for weaning off tracheostomy, protocol for weaning. One way speaking valves – valve opens during inspiration on superior curve of tube Humidification : Swedish nose, to prevent crusting

Tracheostomy Tubes PERMANENT TUBES Metal ( Silver) Tubes - Chevalier Jackson and Negus They have fenestrations and inner tubes. Easier to clean.

Tracheostomy Tubes PROBLEMS 1. Infection 2. Mucous plugging 3. Require humidification 4. Regular suctioning 5. Swallowing problems due to indenting of oesophagus