1. การดูแลผู้ป่วย Tracheostomy
นพ.เธียรไชย ภัทรสกุลชัย
ภาควิชา โสต ศอ นาสิกวิทยา
คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่

2. Tracheostomy patient’s care
Pre-operative assurance
Intra-operative period
Post-operative tracheostomy care
Long-term tracheostomy care

3. Pre-operative assurance
Indications
Advantages over endotracheal tube
Post-tracheostomy status
speaking
eating
Complications

4. Intra-operative period
Immediate complications
Patient’s position
Skin incision - Tracheal incision
Tracheal suture
Tracheostomy tube
Type
Size
Length
Skin closure

5. Post-operative tracheostomy care
Early complications
Secretion →( Nebulizer )
Color, Quantity, Viscosity
Dyspnea
Infection
Dysphagia
Communication

6. Long-term tracheostomy care
Late complications
Communication
Home care
Try off tube

8. Indications for tracheostomy
Upper airway obstruction
Severe aspiration
Prolonged intubation ʘ

9. Advantages of tracheostomy
Reduces patient discomfort
Reduces need for sedation
Ability to maintain oral and bronchial hygiene
Reduces risk of laryngotracheal trauma
Reduces dead space and work of breathing ʘ

10. Immediate complications
Apnea due to loss of hypoxic respiratory drive
Bleeding
Pneumothorax or pneumomediastinum
Injury to adjacent structures
Postobstructive pulmonary edema ʘ

11. ʘ

12. Tracheal incision

13. Tracheal incision

14. Tracheal incision ʘ

15. Types of tracheostomy tube
Material
Metal (Silver-Stainless steel)
Plastic (Polyvinyl chloride)
Silicone
Cuffed or Uncuffed
Single or double tubes
Fenestrated tubes

18. ʘ

19. Early complications Early bleeding Subcutaneous emphysema
Plugging with mucus
Displacement
Atelectasis
Tracheitis
Cellulitis ʘ

20. ʘ

21. Late complications Bleeding Granulation Tracheomalacia Scarring
Stenosis
Tracheoesophageal fistula
Tracheocutaneous fistula
Granulation
Scarring
Failure to decannulate ʘ

22. Home tracheostomy care
Care for your stoma
Clean the inner cannula
Tracheostomy tube holder
Know basic safety and what to do in an emergency

23. Basic safety Bathing: Trouble breathing: Secretion: Tube dislodgement:
Protection of foreign body:

25. ʘ

27. Complications of tracheostomy
Immediate complications
Early complications
Late complications