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Questions and Answers

What is a contraindication for performing a tracheostomy?

  • Retained secretions
  • Uncorrected coagulopathies (correct)
  • Diaphragm paralysis from neuromuscular disorders
  • Inability to protect airway

    • What is a role of the RT in tracheostomy?

  • Prescribing medication
  • Performing surgery
  • Making ventilator changes as needed (correct)
  • Performing bronchoscopy

    • What type of tracheostomy tube has an inner lumen that can be removed for cleaning and replaced?

  • Double lumen tube (correct)
  • Single lumen tube
  • Fenestrated tube
  • Cuffed tube

    • What is a disadvantage of single lumen tubes?

    <p>Can easily become blocked</p> Signup and view all the answers

    What is the primary purpose of a tracheostomy?

    <p>To provide and maintain a patent airway</p> Signup and view all the answers

    What is the purpose of the obturator in a tracheostomy tube?

    <p>To introduce the trach tube in a non-traumatic fashion</p> Signup and view all the answers

    What type of tracheostomy is performed in the ICU at the bedside?

    <p>Percutaneous Tracheostomy</p> Signup and view all the answers

    What is a common indication for tracheostomy due to upper airway obstruction?

    <p>Retropharyngeal abscess</p> Signup and view all the answers

    What is the range of sizes for tracheostomy tubes?

    <p>2.5mm to 11mm</p> Signup and view all the answers

    What is the purpose of the face plate (flanges) in a tracheostomy tube?

    <p>To sit flush against the neck</p> Signup and view all the answers

    What is a type of tracheostomy that can be done in an emergency?

    <p>Mini-tracheostomy</p> Signup and view all the answers

    What is an indication for using a single lumen tube?

    <p>Maximizing the inner lumen of the tracheostomy tube</p> Signup and view all the answers

    What is a long-term benefit of tracheostomy?

    <p>Permitting long-term positive pressure ventilation</p> Signup and view all the answers

    What is a complication of prolonged intubation that may require tracheostomy?

    <p>Ventilator dependence</p> Signup and view all the answers

    What is a type of tracheostomy that is performed under emergency circumstances?

    <p>Emergency Tracheostomy</p> Signup and view all the answers

    What is a benefit of tracheostomy in terms of breathing?

    <p>Increase in volume of air entering the lungs</p> Signup and view all the answers

    What is a potential risk associated with the use of tracheostomy tubes?

    <p>Increased risk of occlusion</p> Signup and view all the answers

    What is the maximum duration a double lumen tracheostomy tube can remain in place?

    <p>30 days</p> Signup and view all the answers

    What is the purpose of the cuff in a cuffed tracheostomy tube?

    <p>To prevent aspiration and allow ventilation</p> Signup and view all the answers

    When is a cuffed polythene tube typically used?

    <p>During and following surgery to the head and neck</p> Signup and view all the answers

    What is a disadvantage of using cuffed tracheostomy tubes?

    <p>Pressure on surrounding tissues causing necrosis, fistula or stenosis</p> Signup and view all the answers

    Why might a patient with a cuffed tube be able to speak?

    <p>The tube is displaced, or the cuff inadequately inflated</p> Signup and view all the answers

    What is a benefit of using double lumen tracheostomy tubes?

    <p>Reduced risk of occlusion due to frequent cleaning</p> Signup and view all the answers

    What can happen if secretions accumulate in a tracheostomy tube?

    <p>The patient's breathing effort increases</p> Signup and view all the answers

    What is a potential complication of high tracheostomy?

    <p>Perichondritis of the cricoid cartilage and subglottic stenosis</p> Signup and view all the answers

    What is the preferred site for tracheostomy?

    <p>Between the 2nd and 3rd tracheal rings</p> Signup and view all the answers

    What is the indication for high tracheostomy?

    <p>Caricinoma of the larynx</p> Signup and view all the answers

    What is the positioning for surgical tracheostomy?

    <p>Supine with pillow under the shoulder and roll under the neck</p> Signup and view all the answers

    What is the location of the skin incision for surgical tracheostomy?

    <p>1cm below the cricoid cartilage</p> Signup and view all the answers

    What is the advantage of percutaneous dilation tracheostomy (PDT)?

    <p>Placement of tracheostomy tube without direct surgical visualization of the trachea</p> Signup and view all the answers

    What is the first step in the PDT procedure?

    <p>Entry into the tracheal lumen below the second tracheal ring with an introducer needle</p> Signup and view all the answers

    What is a potential complication of low tracheostomy?

    <p>Tracheostomy tube impingement on the suprasternal notch</p> Signup and view all the answers

    What is one of the advantages of Percutaneous Dilational Tracheostomy (PDT) over Surgical Tracheostomy (ST)?

    <p>Less clinically significant wound infection</p> Signup and view all the answers

    What is a common complication of tracheostomy?

    <p>Pneumothorax</p> Signup and view all the answers

    What is a contraindication for Percutaneous Dilational Tracheostomy (PDT)?

    <p>Children</p> Signup and view all the answers

    What is a way to decrease the incidence of subglottic stenosis after tracheostomy?

    <p>Using low pressure cuffs</p> Signup and view all the answers

    What is a long-term complication of tracheostomy?

    <p>Tracheal stenosis</p> Signup and view all the answers

    What is a potential disadvantage of Percutaneous Dilational Tracheostomy (PDT)?

    <p>Requires special equipment</p> Signup and view all the answers

    What is a way to confirm the placement of the tracheostomy tube?

    <p>Visualizing the tracheobronchial tree through the tube</p> Signup and view all the answers

    What is a potential complication of tracheostomy that can occur during the procedure?

    <p>Accidental decannulation</p> Signup and view all the answers

    Study Notes

    Tracheostomy Definition and Objectives

    • Tracheostomy is a surgical opening in the anterior wall of the trachea, just below the larynx, which bypasses the upper passages (pharynx and larynx)
    • Learning objectives: define tracheostomy, indicate its purposes, recognize types and parts of tracheostomy tubes, identify complications, and understand the role of RT in tracheostomy care

    Types of Tracheostomy

    • Temporary or permanent tracheostomy
    • Emergency or elective tracheostomy
    • Surgical (open) tracheostomy: incision to trachea between 2nd and 3rd tracheal rings
    • Percutaneous tracheostomy (PDT): can be done in ICU at the bedside
    • Mini-tracheostomy and cricothyroidotomy: can be done in emergency situations

    Indications of Tracheostomy

    • Upper airway obstruction due to infections, trauma, neoplasms, oedema of larynx
    • Obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) when CPAP and medical therapies fail
    • Ventilator dependence: prolonged intubation, inability to protect airway, and diaphragm paralysis
    • Retained secretions

    Contraindications of Tracheostomy

    • Skin infection
    • Prior major neck surgery which completely obscures the anatomy
    • Uncorrected coagulopathies (bleeding tendency)

    Role of RT in Tracheostomy

    • Managing the trach tube
    • Making ventilator changes as needed
    • Assisting with bronchoscopist
    • Monitoring the patient

    Tracheostomy Tubes

    • Types: single lumen, double lumen, cuffed, un-cuffed, fenestrated, un-fenestrated
    • Parts: outer cannula, inner cannula, obturator, face plate (flanges), inflatable cuff, and pilot balloon

    Single Lumen vs Double Lumen Tubes

    • Single lumen tubes: require replacement every 5-7 days, disadvantages: short term use, can easily become blocked
    • Double lumen tubes: inner lumen can be changed/cleaned frequently, reducing the risk of occlusion, can remain in place for a maximum of 30 days

    Cuffed Tubes

    • Allow ventilation and prevent aspiration
    • Inflatable cuffs are used when an air-tight seal is required around the tube
    • Disadvantages: cuff exerts pressure on surrounding tissues, causing damage, and patients cannot speak when the cuff is inflated

    Tracheostomy Procedure

    • Site of tracheostomy: high, mid, or low
    • High tracheostomy: above the level of thyroid isthmus, may cause perichondritis of the cricoid cartilage and subglottic stenosis
    • Mid tracheostomy: preferred site, done through the 2nd and 3rd rings, needs division of thyroid isthmus or its retraction
    • Low tracheostomy: done below the level of isthmus, trachea is deep, and close to several large vessels

    Percutaneous Dilation Tracheostomy (PDT)

    • Placement of a tracheostomy tube without direct surgical visualization of the trachea
    • Advantages: less tissue trauma, tighter fit between cannula and skin, and less clinically significant wound infection

    Complications of Tracheostomy

    • Perioperative complications: pneumothorax, wound infection, bleeding, difficult insertion, accidental decannulation, occlusion due to secretions, air embolism, and aspiration
    • Long-term complications: subglottic stenosis, tracheal stenosis, oesophago-tracheal fistula, vocal cord dysfunction, and chronic recurrent laryngeal nerve injury

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