tracheostomy by mukesh

8/8/2019 Tracheostomy by Mukesh

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TRACHEOTOMYTRACHEOTOMY Operative procedure that

creates an artificial opening in the trachea.

TRACHEOSTOMYTRACHEOSTOMY Converting this opening toConverting this opening to

aa permanent or semi permanent stoma on thestoma on theskin surface.skin surface.

The first correct description of the tracheotomy operation-- Ibn Zuhr in the 12th century.

The currently used surgical Tracheostomy technique

-Dr. Chevalier Jackson from Pittsburgh, Pennsylvania.


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1. Emergency Urgent establishment of Airway

2. Elective

i. Therapeutic

Respiratory obstruction

Tracheobronchial Secretions Assisted Ventilation

ii. Prophylactic

Anticipated obstruction or aspiration

3. Permanent

Bilateral Abductor paralysis

Laryngeal Stenosis


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Whenever possible Endotracheal intubation.

Position Supine with neck extended

to bring trachea forward.

Anesthesia 1-2 % Lignocaine with EpinephrineNot needed in Emergency & Unconscious

patients.


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1. Vertical skin incision along

relaxed skin tension lines 1 cm below the cricoid

two finger breadths above the sternal notch.

r

ransverse incision 5cm long, finger

breadth above sternal notch.


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2. Retractors are placed, the

skin & tissues are

dissected in the midline.

Dilated veins are ligated.


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3. The strap muscles are visualized in the midline & the

muscles are divided along the raphe, then retracted

laterally


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4. The thyroid isthmus lies in the field of the dissection.Typically, the isthmus is to 10 mm in its vertical dimension,

mobilize it away from the trachea and retract it or divide the

thyroid isthmus between the ligatures.

. Few drops of4% Lignocaine injected.


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6. Then place the tracheal incision in the second or third

tracheal interspace. A vertical incision is converted to circular

opening.

An inferior based flap, or

Bjrk flap, (through 2nd & 3rd

Tracheal rings) is commonly

used.


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7. The windpipe and

surrounding area is completely

suctioned of all secretions and

blood.

8. Insert Tracheostomy tube (with

concomitant withdrawal of

endotracheal tube), secure with tapearound neck.


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9. Gauze dressing


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Guide wire and catheter are

advanced together into the trachea

as far as the skin positioning marks

on the guide catheter to the skin.

Guide wire introduction, with

removal of sheath


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Guide wire, guide catheter,and dilator unit are advanced

together into the trachea to

the skin positioning mark

The tracheotomy tube is loaded onto adilator and advanced into the trachea over

the guide wire and catheter. The guide wire

and catheter are removed, leaving only the

tracheostomy tube in the trachea


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1.Ciaglia - the

sequential insertion and

removal of a series(usually 4- ) of

increasing larger

dilators over the wire

into the trachea.

2.Griggs - insertion of

a specially designed

pair of guide-wire

forceps along the wireinto the trachea and

then are opened to

complete the dilation

in one step.


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3.Rhino - insertion of a

single large tapered

dilator over a plastic

guidewire

reinforcement.

4.Frova Percutwist -

insertion of a specially

designed screw of

increasing diameter

which rotates to create

the dilatation.


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METAL TRACHEOSTOMYTUBES

1. Fullers Tracheostomy tube

2. Jacksons Tracheostomy

tube


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1. Cuffed Tracheostomy Tube

NON - METALLLIC

TRACHEOSTOMY TUBES

2. Cuffless Tracheostomy Tube


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Neonatal Tracheostomy Tubes ( Portex &

Silastic )

Humidifier Speaking valve


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tracheostomy by mukesh

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