tracheostomy

موضوع: tracheostomy الخميس مارس 10, 2011 10:28 am

Tracheostomy

Def :

A surgical opening or stoma made through the second or third and fourth cartilaginous ring of trachea

* Indication :

*prolonged need for artificial airway ( more than 3
weeks )

*Acute upper airway obstruction

*Chronic upper airway obstruction including obstructive sleep apnea

*Intolerance to endotraceal tube

*Retention of bronchopulmonary secretion

*Predisposition to pulmonary secretion

*prophylaxis in anticipation of acute airway
management problem ( burn , radial neck surgery )

*Post laryngectomy

*Congenital anomalis of the face and neck that make intubation impossible

* Purpose :

* Maintain patent airway

* Improve patient comfort

* Permit speech for the patient

* Increase patient mobility

* Facilitate oral nourishment

* Facilitate transfer from ICU

* Types:

* Disposable or reusable

* Cuffed or non cuffed

plastic or ****l

* Temporary or permenant

* Components :

Outer tube

Inner tube

Flang ( wings )

Pilot cuff

Inflated ballon

Spaeking valve

Air inlet line

Tracheostomy button or cap

* Tracheostomy care :

Elevate head of the bed 30-40 degree unless

contraindicated

Change p.t position frequently

Avoid excessive cough pressure

Keep the O2 heated and humidified

Make chest physiotherapy every 2 hours

Suction only if necessary

Check ventilator tubing or T-tube frequently to ensure

that is no pulling on the tracheostomy tube

Do all tracheostomy care procedure with aseptic

technique

Use the smallest possible feeding tube

Check placement of feeding tube every 4 hours

Monitor fluid and Wt regularly

Communicate with the p.t even unconscious

Keep the tracheostomy ties tight enough

If the p.t has a disposable inner cannula , remove and
replace it with another sterile one every 24 hrs

If he doesn't have a disposable inner cannula , follow

procedure for cleaning the iner cannula

If tracheostomy ties doesn't have an inner cannula concentrate exclusively on wound care

Keep the p.t well hydrated 2-3 litres of fluid per day
uless contraindicated ( Renal disease , CHF , pULMONARY EDEMA , Increased intracranial pressure )

Clean the wound around tracheostomy tube and inner cannulaat least every 8hrs

* Changing the tube :

* The physician change the first tube 2-7 days after surgery

The tube is changed once a week in acute setting &* about once every month or every two months for the clinic or home

The acute care p.t is (NPO) for afew hours before the tube changes

* Extubation :

Removal of the tracheostomy when the indication for intubation is no longer present and when the p.t is able to clear his own secretion and protect the airway from secretion and protect the airway from aspiration

* post extubation care :

Stay with the p.t until he feels confident that he can breathe on his own without dificulty

Obseve the presence of stridor , which indicate airway narrowing to less than 5 mm which can be treated with corticosteroids and reintubation as ordered

Observe signs indicating laryngospasm , supraglottic edema , SIgns of aspiration and hoarsness of voice
Report immediately if there is any abnormality

* Complication :

Hemorrhage : May occur within 48 hrs after tube insertion

Trauma : during tube insertion ( hemorrhage , s.c emphysema , thyroid gland injury , pneumothorax )

Hypoxemia : & segal nerve stimulation

Stoma ifection

Tracheo-esophageal fistula due to excessive cuff pressure

Agitation : Arises from pain and discomfort

video :