Tracheostomy: Presented By: Barte, Hannah Aida D. Balamurugan, Rameebha

TRACHEOSTOMY
PRESENTED BY:
BARTE, HANNAH AIDA D.
BALAMURUGAN , RAMEEBHA
OBJECTIVES
 Definition
 Indications
 Trach Tube
 Preparation
 Procedure
 Types
 Complication and after care.
Tracheostomy
 Operative procedure, creates a surgical
airway in the cervical trachea.
 greek origin- stoma – mouth
 creation of mouth between trachea and
cervical skin
 It can be:
 temporary
 permanent
Indications
1. Upper airway obstruction
2. Pulmonary ventilation
3. Pulmonary toilet
4. Elective procedures
5. Others…….
PARTS OF TRACH TUBE:
1. Faceplate
- Sutures are connected to
secure the tube in place.
2. Outer Cannula
Main body of the tube that
is inserted into the trachea
3. Inner Cannula
Can be removed for cleaning
or replacement to help
manage secretions.
PARTS OF TRACH TUBE
4. Shaft
 Standard are typically
75mm in length
5. Cuff
 blocks the airway when
inflated by way of
the inflation line.
6. Obturator
osometimes called pilot
o assist the insertion of the
tracheostomy tube
Trach Tray Set
METAL vs. PLASTIC
Metal Plastic
silver stainless steel Polyvinyl chloride or
Silicone
Not commonly used Most commonly used
-rigid construction -thermolabile
-uncuffed -adjustable to ptx
-lack a 15 mm connector tracheal anatomy
for the attachment of - centers in the distal tip
ventilator of trachea
PREPARATION:
 surgeon must determine if patient is a good

candidate
 obtain written informed consent
 tracheostomy team discusses entire sequence and

alternatives to the procedure.
PROCEDURE:
 Patient will lie supine on the operating table
 Anesthesiologist or anesthetist keep the airway patent.
 Unconscious patients /Emergency Tracheostomy, no
anesthesia.
 Neck extended properly. Roll is for proper positioning.
 Identify the landmarks:
 Sternocleidomastoid muscle
 Thyroid cartilage
 Cricoid cartilage
 Trachea
 Transverse incision= 2-3 cm

 Subcutaneous dissection
PROCEDURE cont…….
 Open fascia  Cuff inflation
 Identify trachea and its  Place Inner tube
second tracheal ring  Connect tube to
 Blunt dissection of the respirator
trachea  Stitch trachea flap to skin
 Place suture on second  Suture skin together on
tracheal ring both sides
 Incise and Create flap  Apply gauze an secure
 Turn the flap and retract the tube around the
tube patients neck
 Insert tracheostomy tube  Check cuff pressure
PROCEDURE
PROCEDURE:
TYPES
1. Elective Tracheostomy
2. Emergency Tracheostomy
3. Mini Tracheostomy
4. High, Mid and Low Tracheostomy
5. Temporary tracheostomy or
Permanent
TYPES
 Elective Tracheostomy
 is complete airway control at all times, unhurried
dissection, careful placement of tracheostomy
tube.
 Emergency Tracheostomy
 Lifesaving and it is done within 2 to 4 minutes
 Mini Tracheostomy
 Suctioning of secretions from the lungs w/o
formal main tracheostomy.
TYPES:
 Temporary Tracheostomy
 done when airway is permanently damaged.
 High , Mild and Low tracheostomy

High= above isthmus, subglottic edema,
infection or stenosis.
Mid= bet. 2nd and 3rd tracheal rings.
Low =below isthmus, injury
Complications:
1. Tracheostomy tube 8. Fistula formation
displacement 9. Difficulty in swallowing
2. Pneumothorax 10. Chest infections from
3. Severe hemorrhage aspiration of secretions
4. Wound infection 11. Tracheal stenosis
5. Formation of crusts in 12. Damage to the laryngeal
the trachea or bronchi nerve.
6. Surgical emphysema in
the neck
7. Mediasternal
emphysema
After Care
1. Patient should have a bell at the bedside/pen and a
paper to communicate .
2. A sterile tracheal dilator, cannulas and introducers,
retractors, dressings and suction tube should be
available always .
3. Suction is often at least every 2-4hrs on first day
4. Inner tube cleaned in Sodium bicarbonate
Na2CO3 every 4hrs
After Care
5. The air entering the trachea must be humidified.
6. If Intermittent Positive Pressure Ventilation
(IPPV) is used, the air must be warmed and
humidified and delivered at the correct rate and
pressure
7. Tenacious secretions is soften with normal saline
via a fine catheter
8. The tube is removed when the indication for
which the tracheostomy was done no longer
exists

THANK YOU
Source:
 http://trachs.com/parts-of-a-trach-tube/
https://www.slideshare.net/prashiddha321/tracheost
omy-42702119
https://www.hopkinsmedicine.org/tracheostomy/abo
ut/how.html
http://www.jotscroll.com/forums/11/posts/130/trach
eostomy-tracheotomy-care-procedure-
complications-indications.html

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TRACHEOSTOMY

 surgeon must determine if patient is a good

 tracheostomy team discusses entire sequence and

 Transverse incision= 2-3 cm

 High , Mild and Low tracheostomy

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