tracheostomy /tra·che·os·to·my/ (tra″ke-os´tah-me) creation of an opening into the trachea through the neck, with the tracheal mucosa being brought into continuity with the skin; also, the opening so created.
Tracheostomy
tracheostomy
tracheostomy [tra″ke-os´tah-me]
tra·che·os·to·my (tr  k - s t -m)n. 1. Surgical construction of a respiratory opening in the trachea. 2. The opening so made. 3. A tracheotomy performed in order to insert a catheter or tube into the trachea, especially to facilitate breathing. |   |
Tracheostomy
An opening through the neck into the trachea through which a tube may be inserted to maintain an effective airway and help a patient breathe.
tracheostomy
[trā′kē·os′təmē]
Etymology: Gk, tracheia + stoma, mouth
an opening through the neck into the trachea through which an indwelling tube may be inserted. After tracheostomy the patient's chest is auscultated for breath sounds indicative of bilateral air exchange and pulmonary congestion, mucous membranes and fingertips are observed for cyanosis, oxygenation is monitored with pulse oximeters, and humidified oxygen is given via a trach collar placed over the tracheostomy tube. The patient is reassured that the tube is open and that air can pass through it. The tube is suctioned as needed to keep it free from tracheobronchial secretions by using a suction catheter attached to a Y-connector. The catheter is rotated, and intermittent suction is applied for no longer than 10 seconds. Complications of tracheostomy include pneumothorax, respiratory insufficiency, obstruction of the tracheostomy tube or its displacement from the lumen of the trachea, pulmonary infection, atelectasis, tracheoesophageal fistula, hemorrhage, and mediastinal emphysema. If the procedure was done as an emergency, the tracheostomy is closed after normal breathing is restored. If the tracheostomy is permanent, such as with a laryngectomy, the patient is taught self-care. Compare tracheotomy.
tracheostomy [tra″ke-os´tah-me]
creation of an opening into the trachea through the neck, with insertion of an indwelling tube to facilitate passage of air or evacuation of secretions. The procedure may be an emergency measure or an elective one.
Tracheostomy Tubes. There are many types of tracheostomy tubes available, but the basic structure is the same. All are curved to accommodate the anatomy of the trachea and most consist of an outer cannula to maintain the patency of the airway and an inner cannula that fits snugly inside the outer cannula and can be removed for cleaning and removal of accumulated secretions without disturbing the operative site. An accessory to the tracheostomy tubes is the obturator (pilot), which is an olive-tipped curved rod that is used to guide the outer cannula and prevent scraping of the tracheal walls while the tube is being inserted.
The earliest tracheostomy tubes were made of silver and consisted of only the three basic components. Later models came with an adaptor on the inner cannula to allow connection with a ventilator. The plastic tracheostomy tubes that are popular today may or may not have an inner cannula, but most have an inflatable cuff attached. The inflatable cuff may be built on the outer cannula, or it may be applied as needed. The cuff that is to be applied must be the proper size in order to be effective. The purpose of the cuff is to hold the tube in place and prevent the flow of air around the outside of the outer cannula. This allows for more effective ventilation of the patient and prevents the aspiration of liquids into the trachea. The cuffs may maintain a constant high or low pressure. Some cuffs are attached to a balloon to allow the pressure to vary in response to conditions within the trachea, for example, when a patient coughs or changes position.
The earliest tracheostomy tubes were made of silver and consisted of only the three basic components. Later models came with an adaptor on the inner cannula to allow connection with a ventilator. The plastic tracheostomy tubes that are popular today may or may not have an inner cannula, but most have an inflatable cuff attached. The inflatable cuff may be built on the outer cannula, or it may be applied as needed. The cuff that is to be applied must be the proper size in order to be effective. The purpose of the cuff is to hold the tube in place and prevent the flow of air around the outside of the outer cannula. This allows for more effective ventilation of the patient and prevents the aspiration of liquids into the trachea. The cuffs may maintain a constant high or low pressure. Some cuffs are attached to a balloon to allow the pressure to vary in response to conditions within the trachea, for example, when a patient coughs or changes position.
Patient Care. The primary concerns of tracheostomy care are maintenance of an adequate airway by keeping the tube free of secretions and prevention of infection. The patient is observed closely for signs of respiratory difficulty. If there is a change in the respiratory rate or a wheezing or crowing sound during inhalation, the tube is probably obstructed. If suctioning does not relieve the situation, emergency assistance should be sought immediately. Restlessness, pallor, and the development of cyanosis are indications of inadequate ventilation of the lungs resulting from obstruction of the airway.
Accidental expulsion of the outer cannula due to violent coughing or improperly tied tapes is rare; should it happen, however, a dilator or hemostat must be used to hold open the incision while another tube is inserted. A dilator, obturator, and tracheostomy tube of the same size as that in the patient are kept at the bedside at all times.
The mucus will be slightly blood-tinged immediately after the tracheostomy is performed, but it should gradually assume a normal color. If there is evidence of persistent bleeding, this should be reported, as it may indicate internal hemorrhage. The mucus is suctioned as necessary with an electric or wall suction apparatus. The size of the catheter to be used for suctioning will depend on the size of the tracheostomy tube. The catheter should be small enough to move freely into and out of the tube and large enough to aspirate secretions effectively. Air inhaled through a tracheostomy tube is moisturized to prevent drying and caking of secretions. The instillation of sterile saline to loosen secretions was formerly done but is no longer recommended.
Tracheostomy care is usually a sterile procedure. Selected patients in home care settings may use clean techniques. Special care must be taken to prevent introduction of infectious organisms into either the surgical wound or the respiratory tract. Standard tracheostomy kits are available and usually include gauze sponges, twill tape, disposable containers for hydrogen peroxide, a small brush, pipe cleaners, and a tracheostomy dressing that is slit so that it fits around the tube. If additional dressings are needed, gauze squares without fillers are used and loose strings must be avoided so that fibers and threads are not aspirated through the tube.
Patients with a permanent tracheostomy must be taught self-care before leaving the hospital. As they become accustomed to breathing through the tube, suctioning it as necessary and replacing the dressings, they will become less apprehensive. Patients must be cautioned against swimming, and should be warned to use care when taking a shower or bath that water is not aspirated through the tracheostomy. Newer models of tracheostomy tubes allow the patient to speak without manually closing off the opening through which air passes into the trachea.
Accidental expulsion of the outer cannula due to violent coughing or improperly tied tapes is rare; should it happen, however, a dilator or hemostat must be used to hold open the incision while another tube is inserted. A dilator, obturator, and tracheostomy tube of the same size as that in the patient are kept at the bedside at all times.
The mucus will be slightly blood-tinged immediately after the tracheostomy is performed, but it should gradually assume a normal color. If there is evidence of persistent bleeding, this should be reported, as it may indicate internal hemorrhage. The mucus is suctioned as necessary with an electric or wall suction apparatus. The size of the catheter to be used for suctioning will depend on the size of the tracheostomy tube. The catheter should be small enough to move freely into and out of the tube and large enough to aspirate secretions effectively. Air inhaled through a tracheostomy tube is moisturized to prevent drying and caking of secretions. The instillation of sterile saline to loosen secretions was formerly done but is no longer recommended.
Tracheostomy care is usually a sterile procedure. Selected patients in home care settings may use clean techniques. Special care must be taken to prevent introduction of infectious organisms into either the surgical wound or the respiratory tract. Standard tracheostomy kits are available and usually include gauze sponges, twill tape, disposable containers for hydrogen peroxide, a small brush, pipe cleaners, and a tracheostomy dressing that is slit so that it fits around the tube. If additional dressings are needed, gauze squares without fillers are used and loose strings must be avoided so that fibers and threads are not aspirated through the tube.
Patients with a permanent tracheostomy must be taught self-care before leaving the hospital. As they become accustomed to breathing through the tube, suctioning it as necessary and replacing the dressings, they will become less apprehensive. Patients must be cautioned against swimming, and should be warned to use care when taking a shower or bath that water is not aspirated through the tracheostomy. Newer models of tracheostomy tubes allow the patient to speak without manually closing off the opening through which air passes into the trachea.
Tracheostomy tube in place.
Parts of tracheostomy tube: A, Inner cannula. B, Outer cannula. C, Obturator.
Two-cuff tracheostomy tube. The advantage of the two-cuff tube is that during prolonged artificial respiration the cuffs may be inflated alternately to prevent pressure necrosis. Circle indicates portion of tube inflated after insertion in patient.
tracheostomy (trāˈ·kē·äsˑ·t
·mē),n surgical procedure used to create an opening into the trachea through the neck that allows the insertion of a tube to restore normal breathing.
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Tracheostomy.
tracheostomy (trā´kēos´tōmē),
n 1. the formation of an opening into the trachea and the suturing of the edges of the opening to an opening in the skin of the neck.
2. surgical formation of an opening into the trachea, usually through the tracheal rings below the cricoid cartilage, to give the patient an airway.
2. surgical formation of an opening into the trachea, usually through the tracheal rings below the cricoid cartilage, to give the patient an airway.
tracheostomy
creation of an opening into the trachea through the neck, with insertion of an indwelling tube to facilitate passage of air or evacuation of secretions. The procedure may be an emergency measure or an elective one.
tracheostomy tube
two identical down-curving, semicircular tubes are fitted one inside the other. They both have wide flanges which fit against the skin when the tubes are inserted in and down through the tracheostomy incision. When the tubes are snugly in position the inner tube is rotated through 180° making the tube self-retaining.
tracheostomy
Surgery The incision in the anterior wall of the trachea to establish an airway Indications Upper airway obstruction–due to congenital lesions or acute events-eg foreign body, diphtheria, bilateral voal cord paralysis,
laryngeal neoplasms, regional trauma, edema, or anaphylactic reactions, or inability to handle upper or lower respiratory secretions Pros Relieves obstruction, ↓ dead air space, therefore the work required for effective ventilation; facilitates
lavage Cons Loss of effective cough; ↑ susceptibility to infection, especially with Pseudomonas spp.
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