Tracheostomy

Dr J.A. Fasunla

Outline

• Introduction• Indications• Types of tracheostomy tubes• Types of tracheostomy• Care of tracheostomy tube

What is tracheostomy

• It is a life saving surgical procedure• Alexandra the great was the 1st person to

perform a tracheotomy on the war field• It is a surgical opening made into the anterior

wall of the trachea and maintained with a special tube

Anatomy of the airway

Indications for tracheostomy

1) Relieve of upper airway obstruction

Relieve of upper airway obstruction

2) Protection of lower airway

Ventilatory support in respiratory insufficiency

3)

4) Tracheo-bronchial toileting

Types of tracheostomy

A) Based on the level of tracheal incision• High: Between 1st & 2nd tracheal rings• Normal: Between 3rd and 4th tracheal rings• Low: Below 4th tracheal ring

Types of tracheostomy

B) Based on the duration• Temporary• Permanent or end tracheostomy

Types of tracheostomy

C) Based on the timing• Emergency• Elective

Types of tracheostomy tubes

Types of tracheostomy tubes

Metallic tracheostomy tube

Plastic tracheostomy tube

Types of tracheostomy tubesPlain tracheostomy tubes Cuffed tracheostomy tubes

Types of tracheostomy tubes

Without inner tube With inner tubes

Fenestrated tracheostomy tube

Tracheostomy with speaking valve

Tracheostomy tube tapes

Brush for cleaning tracheostomy tube

Tracheostomy operation• Ensure that it is indicated• Obtain informed and understood consent• Anesthesia: Local or general• Incision: Transverse skin crease incision about

4cm above the sternal notch• Blunt dissection of subcutaneous tissue and

muscles until trachea is visualized • Tracheal incision: Vertical or horizontal • May raise Bjork flap In children

Tracheal incisions for tracheostomy

Tracheostomy tube insitu

Tracheostomy tube insitu with a dressing

Immediate tracheostomy care

• Change tracheostomy dressing as required• Keep a suction machine by the patient’s bed

side and suction tube as required• Patient cannot talk hence, leave

communication material by the bed side such as bell, Pen and paper

• Nurse patient in a humidified room to prevent inhalation of dry air and crust formation

Tracheostomy care

• Instil sodium bicarbonate or normal saline into tracheostomy tube to prevent crusting or to soften the formed crust

• Change cuffed tracheostomy tube to plain after 48hours

• Remove stitches after 5 days

Thank you for your attention