TRACHEOSTOMY

Definitions:

TRACHEOTOMY: Incision made below the

cricoid cartilage through the 2nd-4th

tracheal rings

TRACHEOSTOMY: The opening or stoma made

by this incision.

TRACHEOSTOMY TUBE: Artificial airway

inserted into the trachea during

tracheotomy

INDICATIONS FOR TRACHEOSTOMY

• Bypass acute upper airway obstruction.

• Chronic upper airway obstruction.

• Facilitate weaning from mechanical ventilation by decreasing anatomical deadspace.

• Prevention / treatment of retained tracheobronchial secretions.

• Prevention of pulmonary aspiration.

COMPONENTS OF TRACHEOSTOMY TUBE 

1. Outer tube

2. Inner tube: Fits snugly into outer tube, can be easily removed for cleaning.

3. Flange: Flat plastic plate attached to outer tube - lies flush against the patient’s

neck.

4. 15mm outer diameter termination: Fits all ventilator and respiratory equipment.

All remaining features are optional

5. 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 via the...

6. Air inlet valve: One way valve that prevents spontaneous escape of the injected air.

7. Air inlet line: Route for air from air inlet valve to cuff.

8. Pilot cuff: Serves as an indicator of the amount of air in the cuff

9. Fenestration: Hole situated on the curve of the outer tube - used to enhance airflow in

and out of the trachea. Single or multiple fenestrations are available.

10. Speaking valve / tracheostomy button or cap: Used to occlude the tracheostomy tube

opening (a) former - during expiration to facilitate speech and swallow,

(b) latter - during both inspiration and expiration prior to decannulation.

BEDSIDE EQUIPMENT

Every patient with a tracheostomy tube should have the following equipment available at the bedside:

• Spare tracheostomy tubes Same size and type as patient is wearing.

Smaller size

• Tracheal dilator.

• Suctioning equipment Suction machine fitted with filter; suction tubing;

suction catheters (see suctioning page for sizes);

gloves (as below); bottle of sterile water to rinse tubing - change daily.

Ensure equipment is assembled and working

properly.

• Humidification equipment Equipment depends on method used - see

humidification page.

Ensure equipment is assembled and working

properly.

• Gloves Non-sterile **

Sterile gloves (for suctioning)

• Infectious waste bag

• Dry clean container for holding the speaking valve, occlusive cap/button or spare inner cannula when not in use. (Get from theatre)

**Natural rubber latex gloves to be used by all except those who have latex allergy.

Nitrile gloves to be used by those with latex allergy.