3 Indications for Tracheostomy 2. PROTECTION OF AIRWAY :Neurological diseases – bulbar palsy, MS, MGTrauma – burns, facial fracturesComa – head injury, CVA, overdoseHead & Neck surgery3. VENTILATORY SUPPORTUsually day10 on ITUExcessive airway secretions
4 Surgical Tracheostomy Chevalier Jackson 1909Horizontal 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.
5 Complications1. Hemorrhage, pneumothorax, surgical emphysaema, recurrent laryngeal nerve damage.2. Tube displacement3. Tube obstruction – mucous plug4. Long term - Tracheal stenosis ( mucosal ischaemia due to over inflation of balloon), tracheo-innominate fistula, tracheocutaneous fistula.
7 Tracheostomy Tubes CUFFED TUBE For protection of airway from aspiration or hemorrhageINNER TUBESFacilitates cleaning and removal of crusted secretionsFENESTRATED TUBESAllows air to flow up to glottis – speech
9 Tracheostomy Tubes SYNTHETIC TUBES Most are made from PVC, silicone, plasticTwo main types 1. SHILEY2. PORTEXThey have low pressure cuffsCHILDREN do NOT have cuffed tubes due to tracheal necrosis- subglottic stenosis
10 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 tubeHumidification : Swedish nose, to prevent crusting
11 Tracheostomy Tubes PERMANENT TUBES Metal ( Silver) Tubes - Chevalier Jackson and NegusThey have fenestrations and inner tubes.Easier to clean.
12 Tracheostomy Tubes PROBLEMS 1. Infection 2. Mucous plugging 3. Require humidification4. Regular suctioning5. Swallowing problems due to indenting ofoesophagus