tracheostomy
TRANSCRIPT
TRACHEOSTOMY
Anatomy
Fig. 1.2 Superficial landmarks: lateral view 1 = zygomatic process of the temporal bone 2 = auriculotemporal nerve and superficial temporal pedicle 3 = caput mandibulae 4 = parotid duct 5 = external auditory canal 6 = angle of mandible 7 = facial pedicle 8 = transverse process of atlas 9 = inferior parotid pole 10 = apex of mastoid 11 = sternocleidomastoid muscle 12 = submandibular gland 13 = apex of greater cornu of hyoid bone 14 = carotid bifurcation 15 = laryngeal prominence 16 = cricoid cartilage 17 = emergence of spinal accessory nerve (peripheral branch) 18 = trapezius and entrance of spinal accessory nerve (peripheral branch) 19 = inferior belly of omohyoid muscle 20 = external jugular vein 21 = clavicle 22 = sternocleidomastoid muscle (clavicular head) 23 = sternocleidomastoid muscle (sternal head)
1 = mental eminence 2 = inferior border of mandible 3 = facial pedicle 4 = submandibular gland 5 = hyoid bone 6 = angle of mandible 7 = sternocleidomastoid muscle 8 = external jugular vein Fig. 1.3 Superficial landmarks: anterior view 9 = laryngeal prominence 10 = cricoid 11 = isthmus of thyroid gland 12 = sternocleidomastoid muscle (sternal
head) 13 = sternocleidomastoid muscle
(clavicular head) 14 = inferior belly of omohyoid muscle 15 = anterior border of trapezius muscle 16 = clavicle
l = larynxt = thyroidms = manubrium sterni1 = sternohyoid muscle2 = thyrohyoid muscle3 = sternothyroid muscle4 = omohyoid muscle5 = cricothyroid muscle6 = superior thyroid artery7 = medial branch of superior thyroid artery8 = thyroid capsule vessel9 = left sternocleidomastoid muscle10 = pretracheal region11 = common carotid artery
l= larynx t = thyroid gland tr = trachea c = clavicle 1 = superior thyroid artery 2 = inferior thyroid artery 3 = right thyroid lobe 4 = isthmus of the thyroid
gland 5 = left thyroid lobe 6 = pyramidal thyroid lobe
(Lalouette’s lobe) 7 = ima thyroid artery 8 = inferior thyroid artery 9 = pretracheal lymph nodes
Definisi
Tindakan Prosedur pembedahan untuk membuka trakea melalui incisi di leher.
INDIKASI
ABSOLUT Impending Airway Obstruction from bulky tumour Partial Laryngectomy Total Glosectomy Disrupted Mandible Bilateral Radial Neck Disection
RELATIF Total or Partial Pharyngectomy Partial Glosectomy Any Operation onthe palate or oral cavity Patient likely to need prolonged postoperative
respiratory support Dificult intubation,patient likely to need futher
anasthesia in near futrure
Timing
Masih KontroversialBeberapa setuju pemasangan dilakukan bila
sudah dipakai alat intubasi selama 14 hari,lamanya dirawat dan ada tidaknya infeksi nosokomial
Utk yang elektif,paling utama adalah optimalisasi keadaan pasien.Idealnya INR minimal 1.5,trombosit lebih dari 50.000,
Pasien dengan kebutuhan PEEsP(Positive End Expiratory Pressures)> 15 CmH2O emfisema subkutan,pneumothorax
PERALATAN
Spesific Management Issues
Expectorationo SaluranUdara harus dijaga bebas dari sekret dan ini
akan lebih efekif dengan menganjurkan pasien untuk batuk,tidak hanya saluran menjadi bersihntapi juga mengembangkan paru,mencegah atelektasis dan pneumonia.
Suctioningo Jika Pasien terlalu lemah untuk batuk sekret harus di
hisap dari trakea,jangan masukan kateter terlalu dalam melebihi dari canul,dilakukan dengan menarik mundur dan gerakan memutar,tindakann tidak boleh lebih dari 10 menit
Type of the tubeo Variasi tergantung keperluan yang akan digunakan
Tube changeso Frekuensi pergantian tergantung dari tipe sekreto Tube bagian dalam dapt diganti tiap 30 menit tetapi
setiap pasien harus dinilai secara berkelanjutano Dengarkan suara Nafaso Jika sekret minimal cukup ganti tube sekali seminggu
Tracheostomy Dressingo Lingkaran disekitarnya harus selalu dijaga
kebersihannya dan dijaga jangan sampai basah.Self Care
o Mengganti tube dalam dari Trakeostomyo Lembabkan dengan spray nebulizero Encerkan sekret yang kental
TAHAPAN TINDAKAN
The first incision is made either horizontally or vertically, midway between the cricoid
cartilage and the sternal notch;
The sternohyoid and sternothyroid muscles are then separated in the midline (at the linea alba)
with a vertical incision
A cricoid hook is used to elevate the larynx so that the tracheal rings are well visualized
The tracheostomy tube flange is then secured to the skin of the anterior neck at four points using 2-0 silk sutures, and a twill tracheostomy tie is
placed.
Komplikasi
Intraoperatifo Pneumothorax/pneumomediastinumo Trauma pada n.Laringeuso Perforasi Dinding posterior trakeafistula
Mesdiatinitis o Perdarahan dari V.Jugularis anterior,istmus tiroid,
Thiroido Airway Fire
Post Operatifo Perdarahan 48 Jam pertamao Perdarahan Minimalo Infeksio Obstruksi Lumen Tubeo Dislodged Tube
Letak Tracheostomy Yang Benar
TERIMAKASIH