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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

3)

Ventilatory support
in respiratory
insufficiency

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
tubes
Plain 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 patients
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