A Tracheotomy is a procedure to create a surgical opening of
the trachea (tracheostomy) to facilitate respiration, by inserting a tube which
bypasses a blockage in the trachea, caused by, for example, trauma, swelling,
tumour, throat muscle paralysis, obstruction. Also for long term assisted
ventilation of comatose patients.
- Upper airway obstruction (infection, tumour...).
- Impaired respiratory function.
- Assists weaning from ventilatory support (ICU patients).
- To help clear upper airway secretions.
• Plastic and silver - silver tubes do not have inner tubes, and must be
changed every 5-7 days. Some plastic tubes are changed every 30 days.
• Cuffed tubes protect the airway in ventilated patients.
• Fenestrated/unfenestrated - may be cuffed. They have a hole in the outer
cannula, which allows air to pass from the lungs to the vocal chords, allowing
patients to breathe normally, to cough secretions, and help voicing.
• Double or single cannula - double ones have an inner and outer tube.
The inner tube reduces the lumen of the outer tube, so that respiratory effort is
increased, but the outer tube allows the stoma to stay open.
- The patient should be supine, with head extended, and under GA.
- An incision is made one inch from the second tracheal ring down.
- The thyroid isthmus is divided - if necessary.
- A hole is made between the third and fourth tracheal rings.
- The anterior portion of the tracheal ring is removed.
- The tracheostomy tube is inserted.