Why and How Tracheostomy done?

                         TRACHEOSTOMY

INTRODUCTION:

• Tracheostomy is making an opening in anterior wall of trachea and covering it into stoma on skin surface
• Types: 

Emergency tracheostomy,

Elective tracheostomy

Permanent tracheostomy

• Mid tracheostomy ideal, commonly used through 2nd and 3rd rings behind isthmus
• Tracheostomy tubes are made of plastic ,soft ,least irritant and disposable 
• They have inflatable cuff, should be deflated at regular interval to prevent -tracheal necrosis due to pressure

FUNCTIONS:

• Respiration through alternative pathway in case of obstruction above the stoma
• Protection of airway from: aspiration of pharyngeal secretion in comatose patient 
• Blood due to injuries in pharynx ,larynx

INDICATION:

• RESPIRATORY OBSTRUCTION:

Infection- Ludwig angina,

Peritonsillar infection

Tumor

Trauma to larynx, trachea

• RETAINED SECRETION:

(Inability to cough)

Comatose patient

Painful cough -trauma to chest

• RESPIRATORY INSUFFICIENCY:

Chronic lung conditions:

Emphyema

bronchiectasis

TECHNIQUE:

• Children is intubated prior to surgery 

Position:

• Supine with neck extended under local or general anesthesia
• Incision can be vertical (emergency case),transverse (elective case)
• Veins on the surface ligated -strap muscle separated in midline-thyroid gland retracted upward with blunt hook
• Trachea exposed -4% xylocaine is infiltrated into trachea 

TRANSVERSE INCISION:

• Between second and third tracheal ring ,two ends joined with another transverse incision
• Appropriate size tracheostomy tube is placed ,cuff inflated 
• Children, vertical or h incision is made

COMPLICATION:

• EARLY:

Bleeding, wrong placement of tracheostomy tube

• INTERMEDIATE:

Secondary infection of wound ,blockage of the tube

• LATE :

Scar 

Tracheal stenosis

CARE :

• Supervision for bleeding ,breathing difficulty 
• Suctioning :regularly every half an hourly
• Deflate cuff every hour for 5 minutes 
• Cleaning of tracheostomy tube