Tracheostomy

Tracheostomy a surgical opening of trachea while tracheostomy creation of stoma at the skin surface, which leads to the trachea. It may be used as temporary or permanent, according to the conditions of the patients.

Indication.

Upper airway obstruction

Swelling resulting from burns

Prolonged ventilation

To provide broncho pulmonary toileting and to protect the airway

Conversion of cricothyroidotomy

An alternate pathway of breathing bypass

The upper airway obstruction

Improve alveolar ventilation

By Congenital
Laryngomalacia(congenital disease)

Vocal cord paralysis

Inflammatory

Acute epiglottis

Acute Laryngo-bronchitis

Diphtheria

Traumatic injury

Malignant conditions

Bilateral abductor paralysis

Foreign bodies

Bronchial asthma

Strider

Types of according to the uses

1.Elective
2.Permanent
3.Emergency

Effect of a tracheostomy.

The larynx is bypassed.
There is a risk of respiratory tract infection.
Foreign body reaction can occur causing local inflammation.

Principle

Consent
Before getting consent from the patients and patients guardians, you must have explained about the precaution, procedure, risk, and complication clearly.
Before the procedure confirms with the ultrasound, whether there is a presence or absence of large blood vessels

Nasogastric feeding should be stopped at least two hours, that may reduce any chance of aspiration of gastric content to the lungs.
Sedation, analgesia drugs, muscle relaxant, and vasoconstriction drugs kept ready before the procedures.
oxygen supply with the appropriate device for delivery with a connector. keep the suction ready.

Bronchoscope for visualization of the bronchus and carina if needed.

It is done under local anesthesia

The percutaneous tracheostomy technique is new and minimally invasive procedures.

The rapid method of insertion with less complication as compared to other conventional methods

The seldinger techniques to guide the specially designed guidewire dilating forceps into the trachea, which then dilates the trachea

Positions

Patient in the supine position with neck extended and a wedge keeps a roll under the shoulder.

Procedure

Before incision of the injection of the 1% lidocaine with 1:20000 epinephrine.
lubricate the tracheostomy tube 2% lignocaine jelly.

The use of an inner cannula reduces the airway size by 1.0 mm

A transverse skin incision overlying the upper trachea, that separating the strap muscle of the neck in the midline by retractors

Often thyroid isthmus may displace or divided to allow for adequate exposure of an anterior surface of the trachea.
The tracheostomy tube placed through the second or the third tracheal ring.
keep the suction ready and oxygen by the side.
After incision inserts the tracheotomy tube with the guide wire or an obturator is take out and suction is done when there is a secretion.
Inflate the cuff and check for the position of the tracheostomy tube with an assessment of chest movement, auscultation after confirmation sees the capnography for the confirmation chest, x-ray must be taken when there is extended pneumothorax.

Instrument Needed

Kit contains mainly scalpels 14 G Cannula

10 CC syringe

Guidewire with introducer

A dilator with different sizes

Guidewire dilating forceps

Suction control valve

Tracheostomy tube and obturator with the lumen

Complication

Tracheal stenosis

Tracheoesophageal fistulas

Patient discomfort

Tracheal trauma (bleeding)

Tracheo-innominate artery damage

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