Introduction, Component, Indication of Tracheostomy

Subject: Medical and Surgical Nursing II (Theory)

Overview

A tracheostomy is a surgical technique that involves creating a hole through the neck into the trachea (windpipe). Typically, a tube is inserted into this incision to establish an airway and remove secretions from the lungs. This tube is referred to as a tracheostomy tube, or trach tube. The goal of tracheostomy is to keep the airways open to allow for therapeutic gas exchanges, to allow for Bronchial toilet: to eliminate tracheal bronchial secretion, to maintain optimal physical comfort, and to prevent aspiration and transmission of harmful microorganisms. Early complications that may occur during or shortly after the tracheostomy procedure include bleeding, air trapped in the lungs (pneumothorax), pneumomediastinum, subcutaneous emphysema, swallowing tube injury, and so on. Many of these early issues can be prevented or dealt with effectively in a hospital setting by our expert surgeons. Later complications that may develop while the tracheostomy tube is in situ include the tracheostomy tube being accidentally removed, infection in the trachea and surrounding the tracheostomy tube, and so on. Tracheostomy tube suctioning is done only when necessary. The sterile technique must be followed. Nurses should be aware that suctioning is frequently required during the initial postoperative period.

Introduction

A tracheostomy is a surgical technique that involves creating a hole through the neck into the trachea (windpipe). Typically, a tube is inserted into this incision to establish an airway and remove secretions from the lungs. This tube is referred to as a tracheostomy tube, or trach tube.

Components of Tracheostomy Care

  1. Inner tube: Fits snugly into the outer tube, can be easily removed for cleaning.
  2. Flange: Flat plastic plate attached to outer tube – lies flush against the patient’s neck
  3. 15mm outer diameter termination: Fits all ventilator and respiratory equipment. All remaining features are optional.
  4. Cuff: Inflatable air reservoir (high volume, low pressure) -helps anchor the tracheostomy tube in place and provides maximum airway sealing with the least amount of local compression. To inflate, air is injected
  5. Air inlet valve: One-way valve that prevents spontaneous escape of the injected air
  6. Air inlet line: A route for air from air inlet valve to cuff.
  7. Pilot cuff: Serves as an indicator of the amount of air in the cuff
  8. Fenestration: Hole situated on the curve of the outer tube- used to enhance airflow in and out of the trachea. Single multiple fenestrations are available.
  9. Speaking valve/tracheostomy button or cap: Used to occlude the tracheostomy tube opening
  10. Former: During expiration to facilitate speech and swallow.
  11. Latter: During both inspiration and expiration prior to decannulation

Purposes

  • To keep the airways open in order to permit therapeutic gas exchanges.
  • To make bronchial toileting easier, eliminate tracheal bronchial secretion.
  • Maintaining maximum bodily comfort
  • To reduce airway resistance.
  • To provide a mechanical ventilation mechanism.
  • To boost respiratory efficiency.
  • To prevent harmful microorganism aspiration and transmission.

Indication

  • Airway obstruction.
  • Hemorrhage after thyroid surgery or upper airway bleeding
  • Need for long-term airway management.
  • Foreign bodies impacted in the larynx.
  • Acute edema of epiglottis eg. Diptheria, facial burns
  • Trauma to the pharynx or larynx.
  • Congenital causes.
  • Laryngeal weakness stenosis
  • Traumatic cause
  • Inflammatory causes, diseases condition
  • Decreased level of consciousness
  • Inability to clear lower air secretion.
  • Tracheal laryngeal fracture.
  • Need for continuous mechanical ventilation
  • Tumor in a respiratory airway.
  • Retained secretion in the tracheobronchial tree:
  • Unconscious patient following head injury and poisoning.
  • Chest injuries pt unable to cough.
  • Paralysis of the muscles of respiration
  • Tetanus
  • To reduce dead space air by 30%
  • For radical surgery in the neck e.g laryngectomy

 

REFERENCE

HealthLine. 2005. 2017 http://www.healthline.com/health/tracheostomy

KidsHealth. 1995. 2017 http://www.rch.org.au/kidsinfo/fact_sheets/Tracheostomy_information_for_parents/

Mandal, G.N. Textbook of Adult Nursing. Kathmandu: Makalu Publication House, 2013.

Mayo Clinic. 1998. 17 August  2016 http://www.mayoclinic.org/tests-procedures/tracheostomy/home/ovc-20233993

MedicineNet. 1996. 2017 http://www.medicinenet.com/tracheostomy/article.htm

Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/002955.htm

Medscape. 1994. 2017 http://emedicine.medscape.com/article/865068-overview

NHS Choice. http://www.nhs.uk/conditions/Tracheostomy/Pages/Introduction.aspx

Web MD. 2005. 2017 http://www.webmd.boots.com/a-to-z-guides/tracheostomy

 

 
Things to remember
  • A tracheostomy is a surgical technique that involves creating a hole through the neck into the trachea (windpipe).
  • Typically, a tube is inserted into this incision to establish an airway and remove secretions from the lungs.
  • This tube is referred to as a tracheostomy tube, or trach tube.
  • The goal of tracheostomy is to keep the airways open to allow for therapeutic gas exchanges, to allow for Bronchial toilet: to remove tracheal bronchial secretion, to maintain optimal physical comfort, and to prevent aspiration and transmission of pathogenic microorganisms.
  • Early complications that may occur during or shortly after the tracheostomy procedure include bleeding, air trapped in the lungs (pneumothorax), pneumomediastinum, subcutaneous emphysema, swallowing tube injury, and so on.
  • Many of these early issues can be prevented or dealt with effectively in a hospital setting by our expert surgeons.
  • Later complications that may develop while the tracheostomy tube is in situ include the tracheostomy tube being accidentally removed, infection in the trachea and surrounding the tracheostomy tube, and so on.
  • Tracheostomy tube suctioning is done only when necessary. The sterile technique must be followed.
  • Nurses should be aware that suctioning is frequently required during the initial postoperative period.
Questions and Answers

A tracheostomy is a surgical procedure that involves creating a hole through the neck into the trachea (windpipe). Typically, a tube is inserted through this opening to provide an airway and remove secretions from the lungs. This tube is referred to as a tracheostomy tube, or trach tube.

  • Airway obstruction:
  • Hemorrhage after thyroid surgery or upper airway bleeding
  • Need for long-term airway management.
  • Foreign bodies impacted in the larynx.
  • Acute edema of epiglottis eg. Diptheria, facial burns
  • Trauma to the pharynx or larynx.
  • Congenital causes:
  • Laryngeal weakness stenosis
  • Traumatic cause
  • Inflammatory causes, diseases condition
  • Decrease level of consciousness
  • Inability to clear lower air secretion.
  • Tracheal laryngeal fracture.
  • Need for continuous mechanical ventilation
  • Tumor in a respiratory airway.
  • Retained secretion in the trachea-bronchial tree:
  • Unconscious patient following head injury and poisoning.
  • Chest injuries pt unable to cough.
  • Paralysis of the muscles of respiration
  • Tetanus
  • To reduce dead space air by 30%
  • For radial surgery in the neck e.g laryngectomy.

Early complications that could occur during or soon after the tracheostomy procedure include:

  • Bleeding.
  • A buildup of air in the lungs (pneumothorax).
  • Air confined to the chest's deepest layers (pneumomediastinum).
  • Surrounds the tracheostomy, there is air under the skin (subcutaneousemphysema).
  • The swallowing tube has been harmed (esophagus).
  • Damage to the vocal cords' motor nerve (recurrent laryngeal nerve).
  • Blood clots, mucus, or pressure on the airway walls can all clog a tracheostomy tube. Suctioning, humidifying the air, and picking the right tracheostomy tube can all help prevent blockages.

Many of these early issues can be prevented or properly managed in a hospital setting by our skilled surgeons.

The procedure could lead to other issues in the future.

Later complications that could develop later on when the tracheostomy tube is in place:

  • Tracheostomy tube removal made unintentionally (accidental decannulation).
  • infection surrounding the tracheostomy tube and in the trachea.
  • Numerous factors, such as friction from a tube that moves too much or bacteria that cause infections and develop scar tissue, can cause damage to the windpipe itself.

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