TRACHEOSTOMY (PowerPoint) by MikeJenny

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									   TRACHEOSTOMY
 a life saving procedure




DONE BY: SAAD ABDEL AZIZ
                  Introduction


 Tracheostomy is a surgically created
 opening in the neck leading directly to the
 trachea (the breathing tube). It is
 maintained open with a hollow tube called
 a tracheostomy tube.
 Terminology: tracheotomy, tracheostomy
 tube, stoma, decannulations,
 Among the oldest described surgical procedures
                              History

 2000 BC: The Rgveda described a healed tracheostomy incision.
 100 BC: Asclepiades described a tracheostomy incision
 400 BC: Hippocrates condemned tracheostomy.
 50 AD: Aretaeus of Cappadocia warned against tracheostomy
 100 AD: Antyllus described the first familiar tracheostomy as a
    horizontal incision
   400 AD: The Talmud advocated longitudinal incision.
   400 AD: Caelius Aurelianus derided tracheostomy as a "senseless,
    frivolous, and even criminal invention of Asclepiades."
   600 AD: The Susruta Samhita contained routine acknowledgment of
    tracheostomy as accepted therapy in India.
   Approx 600 AD: Dante pronounced tracheostomy "a suitable punishment
    for a sinner in the depths of the Inferno.“
                                      History cont’d

 1546: Brasavola first to published an account of
    tracheostomy for tonsillar obstruction.
   1561-1636: Sanctorius was the first to use a trocar and
    cannula(for 3 days).
   1550-1624: Habicot performed a series of 4
    tracheostomies(FB)
   1702-1743: George Martine developed the inner cannula.
   1718: Lorenz Heister coined the term tracheotomy,
    previously known as laryngotomy or bronchotomy.
   1805: Viq d'Azur described cricothyrotomy.
   1833: Trousseau reported 200 patients with diphtheria
    treated with tracheostomy.
   1921: Chevalier Jackson codified indications and
    techniques for modern tracheostomy
Clinico-Pathology Seminar: Dept. of ORL, UITH.
                 Relevant Surgical Anatomy

1 - Vocal cords
 2 – Thyroid
cartilage
•3 - Cricoid
cartilage
• 4 - Tracheal
cartilages
• 5 - Balloon cuff



Clinico-Pathology Seminar: Dept. of ORL, UITH.
                  Indications

 1. Mechanical obstruction of the upper airways.
 2. Protection of tracheobronchial tree in patients at
  risk of aspiration.
 3. Respiratory failure.
 4. Retention of bronchial secretions.
 5. Elective tracheostomy, e.g. during major head
  and neck surgery a tracheostomy can
  provide/improve surgical access and facilitate
  ventilation.

                                     Clinico-Pathology Seminar:
                                     Dept. of ORL, UITH.
Indications: Mechanical Obstruction
                 Indications: contd

 PROTECTION of AIRWAY
   Neurological Diseases(Polyneuritis eg GBS, MN Diseases)
   Coma (GCS<8, risk of aspiration)

 RESPIRATORY FAILURE
   Pulmonary Disease
   Flail Chest

 RETENTION of SECRETIONS
   In acute resp. infection, pulmonary disease etc

 Elective Tracheostomy as Adjunct to H&N surgeries
   <14 days on ETT(relative)
   >21 days on ETT
                            Contraindications

 No absolute contraindications exist to tracheostomy
 RELATIVE
   Laryngeal CA(strong)

 it may lead to increased incidence of stomal
  recurrence(a diffuse infiltrate of neoplastic tissue at the junction of the amputated trachea
  and skin )
               Types of Tracheostomy Tubes




Bivona Fome-
Cuff                    Montgomery
Tracheostomy                            Metal TT
Tube                    T-Tube




Single
Cannular                             Single
Shiley
                                     Cannular
Pediatric TT
                                     Shiley
                                     Pediatric TT
                      Types of TT cont’d

 Fenestrated cuffed tube



 This 16 Fg single lumen PVC
  tube is most commonly used to
  provide an airway in the
  emergency situation until the
  patient improves or a more
  permanent airway can be
  established.
 The tube is sometimes used at
  the end stages of weaning,
  although due to its longer
  length (92 mm) compared to a
  standard tracheostomy tube,
  patients can report irritation
  from the tube.
Cuffed TT
Uncuffed TT
                      Speaking Valve

A tracheostomy speaking
valve is a one-way valve
that allows air in, but not
out. This forces air
around the tracheostomy
tube, through the vocal
cords and out the mouth
upon expiration, enabling
the patient to vocalize
                 Special Instrument

 Good functional suction
    machine
   Good light source
   Travis self-retaining
    retractor
   Cricoid Hook
   Negus Tracheal dilator
   Tracheostomy
   Anaestetic catheter mount
                    Procedure

 GA and Elective
 Anaesthetist has adequate
 access to ETT
                                   Procedure cont’d

 Skin Prep with
  povidine iodine,
  chlorohexidine(sa
  vlon)
 Draping
 Good light source
  and suction
  machine ready
  and tested to be
  functional

Clinico-Pathology Seminar: Dept. of ORL, UITH.
                                   Procedure cont’d


 Transverse Incision
 Incision 1 cm below the
  cricoid or halfway
  between the cricoid and
  the sternal notch.
 Incision length=6cm/
  anterior border of SCM
  msc lateral


Clinico-Pathology Seminar: Dept. of ORL, UITH.
                                   Procedure cont’d

 Blunt dissection of
  subcut tissue
 Transversely
 Retracted as shown




Clinico-Pathology Seminar: Dept. of ORL, UITH.
                                   Procedure cont’d

 Strap msc is divided
   longitudinally at
   midline




Clinico-Pathology Seminar: Dept. of ORL, UITH.
                                   Procedure cont’d

 Langerbeck retractor
  used to retract
  laterally
 Thyroid ismuth is
  divided at midline by
  2 haemostat and cut
  edge secured by 2/0
  vicryl




Clinico-Pathology Seminar: Dept. of ORL, UITH.
                                   Procedure cont’d

 Thyroid ismuth is
   divided at midline by
   2 haemostat and cut
   edge secured by 2/0
   vicryl




Clinico-Pathology Seminar: Dept. of ORL, UITH.
                                   Procedure cont’d

 Depending on the the
   TT size abt 4cm
   longitudinal opening is
   made to trachea below
   2nd ring




Clinico-Pathology Seminar: Dept. of ORL, UITH.
                  Procedure cont’d

 Negus trachea
 applied and
 TT inserted in
 between
            Procedure cont’d

 Tube is
 anchored
       Percutaneous Tracheostomy
               Technique

 Percutaneous tracheostomy in not indicated for
 gaining access to the airway in emergency situations
 and should not be confused with cricothyroid
 puncture. The procedure is most commonly
 performed at the beside in the intensive care unit
 with the patient sedated and fully monitored
       Percutaneous Tracheostomy
               Technique


 Introduction of
tracheal needle

 Placement of
guide wire
       Percutaneous Tracheostomy
               Technique

 Insertion of
guiding catheter




 Serial dilation
      Percutaneous Tracheostomy
              Technique

 Placement of tracheostomy tube
                 Post-Op Managment

 PCV check(pressure controlled
  ventilation)

 Repeat X-Ray soft tissue
  neck
 Strong Analgesia
 Antibiotics
 IV fluid until able to
  tolerate orally
  Complications of Tracheostomy



 Complications 5-40%


 Mortality <2%


 Complications are more frequent in emergency
 situations, severely ill patients
Surgical Complications
  WEANING FROM TRACHEOSTOMY



 Demonstrate stability for 24 to 48 hours after
 discontinuation of mechanical ventilation.

 Tracheostomy stomas can narrow markedly or
 close within 48 to 72 hours after tube removal.

 Deflating the tracheostomy cuff and capping the
 tube
 The End
Thank You

								
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