TRACHEOSTOMY

Tracheostomy is a procedure in which an artificial opening is created in the throat to assist with patient's breathing or to create an alternate airway it is a fairly common procedure in patients with prolonged ICU stay or ventilator support.

• indications for tracheostomy -

tracheostomy may be needed when there is -

some sort of upper airway obstruction eg cancer of the larynx laryngeal edema etc - if patient is unable.
remove respiratory secretions eg coma respiratory muscles paralysis in such cases tracheostomy allows suctioning of the secretions and the cuff of the tracheostomy reduces further aspiration of secretions.
if the patient has respiratory insufficiency eg chronic lung diseases then tracheostomy might help oxygen ventilation by reducing respiratory dead space.
prophylactic measures in a patient on prolonged mechanical ventilation via endotracheal tube there is a risk for tracheal stenosis so in such patients tracheostomy is done v as part of another procedure sometimes tracheostomy is done to gain access to airway for general anaesthesia or as a precautionary measure in some patients who undergo an extensive neck surgery.



type of tracheostomy -

there are various types of tracheostomy procedures depending on the circumstances of the patient and the treatment intent similarly there are various types of tracheostomy tubes each with specific functions the common types of tracheostomy procedures are-

emergency tracheostomy 
elective tracheostomy
permanent tracheostomy
percutaneous tracheostomy
mini tracheostomy also known as cricothyroidotomy

tracheostomy can also be classified as high mid or low depending on the level at which it is inserted into the trachea different varieties of tracheostomy tube include -

cuffed 
non cuffed 
double-lumen tubes 
tubes with speaking valves
 metallic tubes

procedure -

the procedure is preferably done under general anesthesia but emergency cases may necessitate local anesthesia only.
there are variations on the technique of the procedure but generally these are the steps the patient is put in a supine position with neck extended.
skin incision which may be transverse or longitudinal is given on the neck subcutaneous fat and platysma are cut .
strap muscles of the neck are retracted or dissected away if thyroid gland is encountered then it is displaced upwards or may be cut any blood vessels.
encountered along the way alligatored incision is given on the trachea a hole is made and the tracheostomy tube is inserted preferably through the second or third tracheal ring the skin incision is closed and the tracheostomy tube is secured to the skin via stitches or simply tied around the neck.

care-

after tracheostomy is done certain precautions and care is required to ensure proper functioning of the tracheostomy tube and to prevent complications 
the tracheostomy forces the air to bypass the nasal and oral passages hence the air entering the tracheostomy is not adequately humidified this dry air leads to increased racheal irritation and secretion production because these secretions may lead to crusting and blockage of the tracheostomy tube 
the first point regarding care is adequate suctioning of the secretions through the tracheostomy tube secondly humidification of air this can be done with humidified air attached to the tube placing a humidifier or steam near the patient's bed or applying a wet porous gauze onto the tracheostomy tube
although the latter is considered a crude measure thirdly keep the patient under regular supervision and ensure that
the tube is functioning and not dislodged since the tracheostomy forces the air to bypass the vocal cords patients would not be able to speak effectively in such cases a notepad and Bell should be provided to the patient.


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