1. TRACHEOSTOMY
Miss H.Babar-Craig

2. 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

3. 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

4. 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.

5. 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.

6. Tracheostomy Site

7. 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

8. Tracheostomy

9. 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

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 tube
Humidification : Swedish nose, to prevent crusting

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

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