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

2. Tracheotomy operative procedure that creates an artificial opening in the trachea. Tracheostomy c reation of permanent or semi permanent opening in trachea.

3. 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.

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

9. 1.Upper Airway Obstruction a.Trauma b.Foreign body c.Infections d.Malignant lesions

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

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

12. 4.Elective Procedures For major head and neck operations.

13. 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

14. Emergency Tracheostomy Within 2-4 mints with vertical incision Cricothyrotomy/mini tracheostomy Transverse incision over the cricothyroid membrane. Keep only for 3-5 days

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

16. 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

17. 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

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

19. PROBLEMS DURING TRACHEOSTOMY CARE 1.Dislocation of tracheostomy tube. 2.Bleeding from stoma or during suction. 3.Blockage of tracheostomy tube. 4.Aspiration and swallowing problems. 5.Speaking problems.

20. HOME CARE PLAN 1.Education and training of the attendant. 2.Supply of dressing, suction catheters and suction machine. 3.When to come to the hospital. 4.Visit by community nurse.