Tracheostomy

Tracheostomy

What is Tracheostomy?

tracheostomy tube

Introduction

Tracheostomy is an operation by which stoma or window is made in the tracheal wall for the purpose of respiration.

Indication of Tracheostomy

  1. Acute and Chronic upper airway obstruction
  2. Maintain patent airway in head and neck surgery
  3. Reduce the risk of pulmonary aspiration
  4. Emergency airway access
  5. Respiratory Paralysis where prolonged intubation is required
  6. Acute Laryngeal Edema eg. Diptheria, Chemical burn and Inhalation of Irritant gases
  7. Excessive tracheobronchial secretion
  8. Foreign body in airway
  9. Injury or pressure to Larynx
  10. Bilateral Abductor Paralysis of vocal cord
  11. Tetanus
  12. Respiratory insufficiency due to Emphysema, Bronchitis, Bronchiectasis

Contraindication of Tracheostomy

  1. Asthma, Chronic Obstructive Pulmonary Disease
  2. Unstable Cervical Spine
  3. Unstable Cardiac Disease
  4. Inability to Cooperate
  5. Severe Hypoxemia

Procedure for Tracheostomy

  1. Preanesthetic medication - Injection atropine 0.6mg half an hour before tracheostomy
  2. Position - The patient is put supine with neck over-extended and chin in the midline
  3. Site - Below isthmus of thyroid gland
  4. Local anesthesia - The part selected is prepared and infiltrated with 2% lignocaine
  5. Procedure - A vertical midline incision is taken about 4 cm long, starting from the suprasternal notch. The skin, platysma and the superficial fascia are cut
  6. The inner margin of sternohyoid muscle is identified and deep layer of cervical fascia is cut
  7. Pretracheal fascia is cut and separated from the trachea
  8. The isthmus is cut between the clamps and its ends ligated
  9. 0.5 ml to 1 ml of lignocaine is injected into the lumen of trachea and fourth and fifth tracheal ring is incised from below upwards
  10. Tracheostomy tube is inserted and tape is tied
  11. The wound of tracheostomy are kept free of secretions by repeated suctions.

Types of Tracheostomy

  1. Emergency
  2. Elective
  3. Permanent

Types of Tracheostomy Tubes

1. Metal Tube : Used for permanent tracheostomy which has inner tube.

metal tracheostomy tube

2. Portex Tube : It has a cuff which can be inflated by injecting the air through outer tube. Balloon gets inflated and secures tracheostomy tube in position.

portex tracheostomy tube

Complications of Tracheostomy

A) During Surgery

  • Injury to trachea and esophagus
  • Injury to recurrent laryngeal nerve
  • False passage

B) Post-operative

  • Blocked tracheostomy tube
  • Surgical emphysema
  • Infection, hemorrhage and ulcerations
  • Pulmonary bronchopneumonia
  • Tracheal stenosis