What is a tracheostomy?
An artificial opening in the anterior wall of the trachea to facilitate ventilation
Can be permanent or temporary.
Name the types of tracheostomy procedures.
- Surgical/formal
- Percutaneous
These procedures differ in their approach and application.
List the indications for performing a tracheostomy.
- Bypass upper airway obstruction
- Trauma
- Provide airway access to allow removal of secretions
- Respiratory insufficiency
- Recurrent aspiration
- Surgical procedures
- Neuromuscular disorders
- Long term ventilation-enables weaning
These conditions necessitate the creation of an artificial airway.
What are some complications associated with tracheostomy?
- Damage to local structures
- Cardiac arrest & apnoea
- Haemorrhage
- Incorrect tube placement
- False tract in front of/alongside trachea
- Tube displacement
- Tube blockage
- Surgical emphysema
- Pneumothorax
- Obstruction of tube
- Infection
- Tracheal necrosis resulting in stenosis or TOF
- Difficulty decannulating
- Scarring
These complications can arise during or after the procedure.
How is a surgical tracheostomy performed?
- Often emergency
- Paediatrics
- Thick, unstable or scarred necks
- Involves skin incision and often sutures
- Usually done in theatre
- Thyroid isthmus dissected
- Oval window made in 2nd/3rd or 3rd/4th tracheal ring
- Tube inserted +/- sutures
- Min 4 days for tract to form
This method is typically used in urgent situations.
What is involved in a percutaneous tracheostomy?
- Controlled/planned event
- Useful on ITU/critically ill patients
- Usually done by anaesthetist in critical care setting
- Needle introduced between tracheal rings
- Flexible bronchoscope used as guide
- Serial dilatation to 28FR
- Tube inserted over dilator
- Min 5 days for dilatation to settle
This method is less invasive and often used for stable patients.
What are the components of a tracheostomy tube?
- Outer tube
- Flange/Plate
- Cuff
- Inner tube
- Pilot balloon
Each component plays a crucial role in maintaining the airway and ensuring proper function.
Name the types of tracheostomies based on descriptors.
- Cuffed
- Uncuffed
- Single lumen
- Double lumen
- Fenestrated
- Subglottic suction port
- Adjustable flange
These descriptors help classify tracheostomy tubes based on their design and function.
What are the red flags indicating potential issues with a tracheostomy?
- Bloody/discomfort
- Visibly displaced
- Clinical signs
- Difficulty breathing
- Noise: voice, snoring, gurgling
- Increasing pressure required for cuff
These signs may indicate complications that require immediate attention.
What is involved in the care of the stoma?
- Stoma cleaning
- Barrier cream
- Monitoring
- Dressing change
- Assess site at least once every 24 hours
- Daily dressing & strap changes
Proper stoma care is essential to prevent infection and ensure healing.
What are the risks of inadequate humidification in tracheostomy patients?
- Loss of heat/moisture in respiratory mucosa
- Damage of respiratory epithelium
Inadequate humidification can lead to increased viscosity of mucus secretions and higher infection risk.
What are some communication methods for tracheostomy patients?
- Lip reading
- Writing
- IPAD/Tablets
- Communication charts
- Alphabet boards
These methods help patients communicate effectively despite their condition.
What does weaning from mechanical ventilation involve?
- Liberation from mechanical ventilation
- Cuff down
- Upper airway scoping
- Rehabilitation
- Swallowing
- Reducing respiratory support
- Restoring normal cough
Weaning is a complex process that requires careful monitoring and support.
What is decannulation?
Ability to maintain own airway without a trachea tube
This process depends on the patient’s anatomy and overall health status.
What are the pros of tracheostomy?
- Better secretion management
- Lower airway resistance
- Patient comfort
- Facilitates progressive ventilator weaning
- Enables early mobilisation
These advantages contribute to improved patient care and recovery.
What are the cons of tracheostomy?
- Surgical procedure with insertion risks
- Stoma care essential
- Cuff leaks or malposition
- Requires staff trained in tracheostomy care
These disadvantages highlight the potential complications and care requirements associated with tracheostomy.
True or false: Tracheostomy improves patient comfort by allowing oral care and speech with cuff deflation.
TRUE
This is one of the significant benefits of tracheostomy, enhancing the quality of life for patients.
Fill in the blank: Tracheostomy facilitates progressive ventilator weaning through _______ and stepwise cuff deflation.
spontaneous breathing trials
This process helps in gradually reducing ventilator dependence.
What risks are associated with the surgical procedure of tracheostomy?
- Bleeding
- Pneumothorax
These risks must be carefully managed during the procedure.
What essential care is required for a tracheostomy stoma?
- Infection prevention
- Blockage management
- Dislodgement prevention
Proper stoma care is crucial to avoid complications.
What are the components of an Emergency Trache Box?
- Dilators
- Cough pressure check
- MHI bag
- 10ml syringe
- Trache, smaller size and same size
- Non fenestrated inner tube
- Dressing
These items are essential for managing tracheostomy emergencies.
What is a Single Cannula tracheostomy?
Outer tube only, usually unfenestrated (e.g., portex)
This type does not have an inner tube.
What is a Double Cannula tracheostomy?
Has inner and outer tube, can be fenestrated (green) or unfenestrated (white) (e.g., shiley)
The inner tube can be removed for cleaning.
What is the purpose of a Cuffed tracheostomy?
Used to form seal in trachea, reduce risk aspiration
Most cuffed tracheostomies are low pressure high volume and can be used with MHI.
