Tracheostomy, tracheotomy procedure explained & 3D video

 

 

Tracheotomy and Tracheostomy: 

 

Tracheotomy and tracheostomy are critical surgical procedures designed to assist patients with severe breathing difficulties. While both involve creating an opening in the trachea (windpipe), they serve different purposes and have distinct procedural nuances.

 

Tracheotomy

A tracheotomy is typically a temporary procedure. It involves making a small incision in the trachea to insert a breathing tube, which is later removed once the patient can breathe independently. The incision generally heals on its own after the tube is removed.

• Prevalence: Tracheotomies are performed on approximately 100,000 patients annually in the United States.
• Duration: The tube remains in place for a short period, usually days to weeks.

 

Tracheostomy

Conversely, a tracheostomy is often a more permanent solution. It involves creating a hole in the trachea and inserting a tracheostomy tube that remains in place for an extended period, providing a long-term airway solution.

• Prevalence: Annually, about 50,000 tracheostomies are performed in the United States.
• Duration: The tracheostomy tube can remain in place indefinitely or until the patient no longer requires it.

 

Indications for Tracheotomy and Tracheostomy

These procedures are indicated in various clinical scenarios, including:

• Airway obstruction: Due to trauma, tumours, or infection.
  • Statistics: Approximately 20% of tracheostomies are due to upper airway obstruction.
• Severe respiratory distress or failure
  • Statistics: 50% of ICU patients who require prolonged mechanical ventilation undergo tracheostomy.
• Prolonged mechanical ventilation
  • Statistics: Tracheostomy is considered after 10-14 days of mechanical ventilation.
• Inability to protect the airway: Due to neurological disorders or impaired consciousness.
  • Statistics: Neurological impairment accounts for around 25% of tracheostomy cases.

 

Steps for Performing Tracheotomy and Tracheostomy

1. Preparation: The patient is positioned, and the neck area is cleaned and draped. Local anesthesia is often used, although general anesthesia may sometimes be necessary.
   • Note: Proper preparation reduces the risk of infection, which occurs in approximately 5-15% of cases.
2. Incision: A small incision is made in the neck, and the muscles and tissues are carefully separated to expose the trachea.
   • Technique: A horizontal or vertical incision is typically 2-3 cm long.
3. Tracheal Opening: An opening is made in the trachea, usually between the second and third tracheal rings.
   • Accuracy: Proper placement between tracheal rings minimizes the risk of complications, which can occur in 1-2% of procedures.
4. Tube Insertion: For a tracheotomy, a tracheostomy tube is inserted through the incision into the trachea and secured.
   • Types of Tubes: The choice between cuffed and uncuffed tubes depends on the patient's needs. Cuffed tubes are used in 80% of tracheostomy cases.
5. Confirmation: Proper tube placement is confirmed by listening for breath sounds and checking for adequate ventilation.
   • Verification: Chest X-ray or end-tidal CO2 monitoring may be used for confirmation.

 

Pre-operative Care

Pre-operative care includes a thorough assessment of the patient's medical history, necessary imaging studies, and lab tests to ensure the procedure's appropriateness and safety. Informed consent must be obtained from the patient or their legal representative.

• Assessment: Includes blood tests, chest X-rays, and CT scans to evaluate the airway.
• Consent: Discuss potential risks, which include bleeding (4-8%), infection (5-15%), and damage to surrounding structures (1-2%).

 

Post-operative Care

Post-operative care involves:

• Monitoring the patient's vital signs.
• Ensuring the tube remains secure and patent.
• Managing any pain or discomfort.

Regular cleaning and maintenance of the stoma (the opening in the trachea) and the tracheostomy tube are crucial for tracheostomy patients to prevent infection and other complications.

• Monitoring includes checking for signs of infection and tube dislodgment and ensuring adequate ventilation.
  • Infection Rate: Post-operative infections occur in 5-15% of patients.
• Maintenance: Regularly clean and change the tracheostomy tube to prevent blockage and infection.
  • Frequency: The tube is typically changed every 1-2 weeks initially, then as needed.

Long-term care may include speech therapy, respiratory therapy, and support from a multidisciplinary team to address ongoing needs.