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TRACHEOSTOMY & CRICOTHYROIDOTOMY PowerPoint Presentation
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TRACHEOSTOMY & CRICOTHYROIDOTOMY

TRACHEOSTOMY & CRICOTHYROIDOTOMY

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TRACHEOSTOMY & CRICOTHYROIDOTOMY

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  1. TRACHEOSTOMY & CRICOTHYROIDOTOMY

  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 • Neck trauma • Tumour • Bilateral vocal cord paralysis • Laryngeal Edema • Respiratory failure

  10. FORMS OF TRACHEOSTOMY • Emergency tracheostomy • Urgent tracheostomy • Elective tracheostomy

  11. INTRAOPERATIVE DETAILS:TRACHEOSTOMY

  12. TRACHY TUBES

  13. TUBE PARTS

  14. METALIC TUBES

  15. PLASTIC TUBES

  16. Chest X-ray after trachy

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

  18. 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.

  19. 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

  20. 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

  21. 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).

  22. 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.

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

  24. WHEN TO SUCTION 1 • Mucus bubbling in trachyostomy tube • Audible gargling sounds • Difficult breathing • Restlessness • Gurgles heard on auscultation • Low SpO2

  25. 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

  26. 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

  27. COMPLICATIONS • IMMEDIATE • EARLY • LATE

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

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

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