General Information about Tracheostomy
Tracheostomy (Tray-kee-AH-stuh-mee) is a surgical opening in the trachea (windpipe) that forms a temporary or permanent opening to make breathing easier.
The terms "tracheotomy" and "tracheostomy" are used interchangeably
The opening is called a stoma.
A tracheotomy tube is inserted in the opening to keep it open.
Emergency tracheostomy is performed as a lifesaving procedure
History:
Tracheostomy in early days was considered slashing of the neck to save a life.
Even though tracheostomy procedure existed right from the Rig Vedas it was
In 1718 that Lorenz Heister coined the term tracheotomy
In 1921 Chevalier Jackson described the indications and techniques for modern tracheostomy.
Tracheostomy - Anatomy
The trachea is also called windpipe
The trachea and esophagus run parallel to each other through the chest cavity.
The esophagus is connected to the stomach, and helps in carrying food and saliva to the stomach.
The trachea, which is connected to the lungs, carries air to the bronchi and the lungs.
As we breathe the air passes through the throat into the trachea (windpipe).
The trachea is then divided into the left and right bronchi.
Each bronchus divides again and again like a branch of a tree, becoming narrower and narrower.
Tracheostomy Indications
Now a days tracheostomy is done only in those cases in which intubation by a mouth or nasal tube is not a feasible option.
There are broadly four groups of patients on whom tracheostomy needs to be performed:
1. To relieve breathing difficulties by any blockage in the airway passages for example-
· Foreign body Impactation in the airways.
· Acute infection of the airways
· Edema of the airways
· Paralysis of vocal cords following injury
· Tumors of the vocal cords
· Trauma in the region
2. To improve respiratory functions by reducing the length of the airway, which may be required in special lung conditions like- Bronchopneumonia
· Bronchitis with Emphysema
· Chest injury
In these conditions the tracheostomy tube also helps in aspiration of excessive secretion that may be caused due to infection or injury
3. Respiratory nerve damage temporary or permanent causing paralysis of chest muscles that assist in breathing. In these situations performing assisted or positive pressure respirations may be required in conditions like-
· Unconsciousness associated with head injuries
· Barbiturate poisoning
· Poliomyelitis
· Tetanus
These patients may also aspirate their gastric content into the lungs and a
tracheostomy tube may be helpful for aspiration these secretions.
4. As a preliminary step in certain surgeries on the upper airway.
Advantages of Tracheostomy
Tracheostomy has certain advantageous over the temporary tube called endotracheal tube because it-
. Reduces patient discomfort
· Reduces need for sedation
· Improves ability to maintain oral and bronchial hygiene
· Reduces risk of trauma to the windpipe and trachea
· Makes breathing easier with less effort for a sick patient
· Easier to move off assisted breathing using a ventilator.
Tracheostomy - Procedure
The patient is made to lie down on their back with the neck & head extended by keeping a pillow under the shoulder and neck.
Local anaesthesia or general anaesthesia is used for the procedure.
A horizontal cut is made across the neck above the 'sternal notch' using a knife.
The skin is separated and surrounding tissues are dissected to expose the trachea.
The 2nd or 3rd of the tracheal ring is incised for the tracheostomy tube to be placed.
A suitable size tracheostomy tube is then introduced inside. While choosing the tube, the smallest feasible tube should be used. A general rule is that the tube should be three fourths of the diameter of the trachea.
The cuff of the tube is inflated by using 2-5 ml of air and it is held in place by using a necktie.
The incision is closed using skin sutures by the side of the tracheostomy tube.
Dressing is applied for the wound to heal.
Tracheostomy- Post Operative Care
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The "Obturator" that is used to pass the trach into the windpipe. And an "Inner cannula" that fits inside the outer one and locks into place. Many of the patients need 1 to 3 days time to adapt themselves to breath through the tracheostomy tube. Painkillers and antibiotics are given as per the patients need. The patient will have to try and make adjustments to communicate. It would be very difficult for the patient to initially make any noise or sounds let alone trying to speak. Most patients can learn to speak with a tracheostomy tube after much training and practice. Once the underlying problem that caused the tracheostomy tube to be placed in the first place in healed then the tube would be removed. A small scar would remain with the hole healing quickly. Long term care for tracheostomy tube Patients or attenders should learn how to take care of the tracheostomy if they are to be discharged home after the procedure. This will help them to take care of the tube at home. Normal lifestyles are encouraged and most activities can be resumed. Some tubes have an inflatable cuff near the outer end to keep them from coming out and to prevent air from leaking around them. As long as the tracheostomy tube is in place, the inner cannula should be cleaned on a daily basis. Whenever the tube seems like becoming clogged with mucus, it will have to be cleared by suction. The procedures are important as a dirty cannula could lead to infection. and if the trach clogs up, the patient will be unable to breath. Cleaning and suctioning of the tracheostomy tube must be followed strictly and is perhaps one of the most important instructions given at the time of discharge. Wound infections Air leakage Improper air entry Tracheal ring narrowing or Stenosis (usually with high tracheostomy) Ulceration of the trachea or main bronchi Entrapment of air under the skin (called surgical emphysema), this is a self-limiting condition that resolves spontaneously. Noisy breathing (a rattling or the sound of mucus bubbling) Rate of breathing increases The person appears uncomfortable, fussy, agitated or restless Inadequate chest movement upon inhalation Nasal flaring Infant has difficulty sucking Mucus can be seen bubbling at the tube opening Non-productive cough Blue colour around the lips, mouth or fingernails (cyanosis)
