Tracheostomy
A tracheostomy is a surgical procedure that involves making an incision in the neck in order to create an opening into the trachea.
Tracheostomy Tube
A tracheostomy tube is a cylindrical tube that is inserted through an incision in the neck and into the trachea. The tube has a hollow center, which allows air to pass through so that breathing can occur.
Parts of simple tracheostomy tube:
- Outer Cannula
- Inner Cannula
- Obturator
- Pilot Balloon
- Cuff
- Cuff Inflation Lines
Indications:
- Patients with neuromuscular disorder
- Patient who need ventilation support for a long time
- Laryngeal Carcinoma
- Large tumor in upper airway (Laryngeopharynx)
- Patient has been on ETT for more than 14-Days
- Severe sleep apnea
- Burns
- Swelling of your tongue, mouth, or airway
- Surgery on your face
Procedure:
- You lie facing up. A nurse cleans your chest and neck with a germ-killing antiseptic.
- An anesthesiologist gives you general anesthesia to make you sleep so you don’t feel any pain. Once you’re asleep, the surgeon will cut into the skin on the lower half of your neck between your larynx and the top of your chest.
- They part the muscle below and may need to move or cut the thyroid gland to get to your windpipe.
- Then, the surgeon cuts a hole in your windpipe and puts in the tube. Stitches, surgical tape, or a Velcro strap will hold it in place.
Draw-Backs of Tracheostomy:
- Patient can't talk or speak when on normal tracheostomy.
Contraindications:
Actually there are few real hard contraindications of tracheostomy:
- Tumor at the level of cricoid cartilage which complicate the insertion of tracheostomy.
- Tracheostomy is contraindicated in patients with severe stenosis of upper airway specifically on larynx.
Complications:
- Bleeding:
It's common for there to be some bleeding from the windpipe (trachea) or the tracheostomy itself.
- Accidental Injury:
The nerves near the windpipe can be accidentally damaged, such as those controlling the voice box (larynx) or the tube that runs from the back of the throat to the stomach (oesophagus). This may cause problems with speaking and swallowing.
- Rarely Infection:
The windpipe or nearby tissues can become infected. If this happens, treatment with antibiotics is usually needed.
- Collapsed lung:
Sometimes air will collect around the lungs and cause them to collapse inwards. This is known as a pneumothorax.
Advantages:
- Reduced sedation requirement (greater comfort than oro-tracheal intubation)
- Airway protection while unconscious
- Avoids laryngeal injury
- Easily replaceable once stoma site is stable
- Easy to clean
- Reduce Dead Space
- Less risk of infections then ETT
- Lifelong used