Tracheostomy UMST PDF

TRACHEOSTOMY Dr Rajab MUGABO Senior Consultant ENT-Head & Neck Surgeon  OUTLINE ▣ Definition ▣ Types ▣ Indications ▣ Surgical anatomy ▣ Tracheostomy care  Definition ▣ Tracheostomy ◼ Surgically created opening in the front of the...

TRACHEOSTOMY Dr Rajab MUGABO Senior Consultant ENT-Head & Neck Surgeon  OUTLINE ▣ Definition ▣ Types ▣ Indications ▣ Surgical anatomy ▣ Tracheostomy care  Definition ▣ Tracheostomy ◼ Surgically created opening in the front of the neck into the trachea ▣ Tracheostomy ◼ Creation of a stoma at the skin surface which lead into the trachea  Types ▣ Temporary ▣ Open tracheostomy ▣ Percutaneous ◼ Elective ◼ Emergency ▣ Permanent  Temporary Tracheostomy versus Permanent Laryngectomy ▣ Temporary: THE UPPER AIRWAY IS STILL PRESENT ▣ Permanent: THE LARYNX IS REMOVED AND AN ARTIFICAL TRACHEOSTOMY IS CREATED – NO CONNECTION BETWEEN THE PATIENT’S UPPER AIRWAY AND THE TRACHEA ITSELF!  Indications ▣ Upper airway ▣ Protection of obstruction tracheobronchial tree ◼ Congenital ◼ Neurological diseases ◼ Trauma ◼ Following trauma ◼ Infections ◼ Coma ◼ Tumours ◼ Head and neck ◼ Vocal cord paralysis surgery ▣ Prolonged ventilation ▣ Tracheobronchial toilet  Surgical technique ▣ Ideally under general anesthetic ▣ The patient is positioned supine with a shoulder roll and a head ring to achieve neck extension ▣ A horizontal neck incision is made midway between the cricoid and sternal notch. ▣ The strap muscles are divided in the midline and retracted ▣ The thyroid isthmus is divided in the midline ▣ Window created in the trachea and tracheostomy tube inserted Surgical technique Relations …  Complications ▣ Bleeding ▣ Pneumothorax ▣ Subctaneous emphysema ▣ Tube misplacement or displacement ▣ Tracheo-oesophageal fistula ▣ Tracheostomy tube obstruction ▣ Accidental decannulation ▣ Infection ▣ Tracheal Stenosis ▣ Tracheocutaneous fistula  Tracheostomy care ▣ Humidification ▣ Suctioning ▣ Wound cleaning ▣ Changing/cleaning inner canulla