1. TRACHEOSTOMY & CRICOTHYROIDOTOMY
DR FRANK EDWIN

2. INTRODUCTION
Tracheostomy is an operative procedure that creates a surgical airway in the cervical trachea
It is considered synonymous with tracheotomy

3. LARYNX & TRACHEA

4. ANATOMY I

5. ANATOMY II

6. ANATOMY III

7. ANATOMY IV

8. UPPER AIRWAY OBSTRUCTION -RECOGNITION
Dyspnea
Stridor
Voice change
Decreased or absent breath sounds
Restlessness
Hemodynamic instability (late)
Loss of consciousness (very late)

9. INDICATIONS FOR TRACHEOSTOMY
To bypass obstruction
Long-term Mechanical ventilation
Pulmonary toiletting
Neck trauma
Tumor
Bilateral vocal cord paralysis
Laryngeal Edema
Respiratory failure

10. FORMS OF TRACHEOSTOMY Emergency tracheostomy Urgent tracheostomy
Elective tracheostomy

11. INTRAOPERATIVE DETAILS: TRACHEOSTOMY

12. TRACHEOSTOMY

14. TRACHY TUBES

15. TUBE PARTS

16. METALIC TUBES

17. PLASTIC TUBES

19. USE OF FENESTRATED TUBE

21. Chest X-ray after trachy

22. POSTOPERATIVE DETAILS
Postoperative care is critical.
Copious secretions is the norm
Suctioning every 15 minutes may be required
Suctioning should be shallow initially
Suctioning should be limited to no more than 15 seconds

23. POSTOPERATIVE DETAILS 2
Humidified oxygen helps prevent inspissation of the secretions.
Mucolytic agents may be employed.
If uncorrected, mucus plugging of the inner cannula can cause a life-threatening obstruction.

24. POSTOPERATIVE DETAILS 3
The original tube is left sutured in place for 5-7 days to allow the tract to heal.
Then the sutures are removed, and the tube is replaced.
The site should be kept clean and dry to minimize infection
Patient and family education should begin ASAP

25. FOLLOW-UP CARE Speaking: should be encouraged when cuff is deflated
Swallowing: Swallowing is more difficult
Evaluate risk of aspiration before feeding
Educate: both patient and family
Equipment: for discharge

26. SUCTIONING
"STERILE TECHNIQUE" - the use of a sterile catheter and sterile gloves for each suctioning procedure.
"CLEAN TECHNIQUE" - the use of a clean catheter and nonsterile, disposable gloves or freshly washed, clean hands for the procedure.
“MODIFIED CLEAN TECHNIQUE" - nonsterile gloves and sterile catheters).

27. SUCTIONING DEPTH
SHALLOW SUCTIONING – suctioning at the hub of the tracheostomy tube to remove secretions coughed up to the opening of the tracheostomy tube.
The PRE-MEASURED TECHNIQUE - the catheter is inserted to a pre-measured depth, with the most distal side holes just exiting the tip of the tracheostomy tube.
DEEP SUCTIONING - the insertion of the catheter until resistance is met, withdrawing the catheter slightly before suction is applied.

28. WHEN IS SUCTIONING REQUIRED?
Whenever patient is unable to clear secretions by coughing
Bleeding down the airway

29. WHEN TO SUCTION 1 Mucus bubbling in trachy tube
Audible gargling sounds
Laboured breathing
Restlessness
Gurgles heard on auscultation
Low SpO2

30. WHEN T SUCTION 2 Stridor or changes in breathing Cyanosis
Increased ventilator inspiratory pressure (for patient on ventilator, a high pressure alarm may sound)
Patient request

31. INSTILLING
Introduction of normal saline into the airway to aid removal of thick, tenacious secretions.
TENACIOUS SECRETIONS
Systemic hydration
Humidification
Chest physiotherapy
Suctioning, coughs and assisted coughs
Mucolytic agents

32. COMPLICATIONS
IMMEDIATE
EARLY
LATE

33. COMPLICATIONS 1 IMMEDIATE Bleeding Pneumothorax/Pneumomediastinum
Injury to adjacent structures

34. COMPLICATIONS 2 EARLY Bleeding Tube obstruction
Tube displacement/dislodgement
Subcutaneous Emphysema
Atelectasis

35. COMPLICATIONS 3 LATE Bleeding Tracheal stenosis Tracheomalacia
Tracheo-esophageal fistula
Failure to de-cannulate