About Tracheostomy

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=200 BGCOLOR="#FFFFFF" TEXT="#080000" background="0a264643.gif"> <div> <IMG SRC="10995810.png" border=0 width="149" height="129" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>What is tracheostomy?</B></div> <bR> <div> <A HREF="id17_m.htm#meet_the_team" TARGET="TRLX_Middle" TITLE="About Tracheostomy"><U><B>Meet the team</B></U></A></div> <bR> <div> <A HREF="id17_m.htm#advantages_of_tracheostomy_over" TARGET="TRLX_Middle" TITLE="About Tracheostomy"><U><B>Advantages of tracheostomy </B></U></A></div> <div> <A HREF="id17_m.htm#advantages_of_tracheostomy_over" TARGET="TRLX_Middle" TITLE="About Tracheostomy"><U><B>over</B></U></A><A HREF="id17_m.htm#advantages_of_tracheostomy_over" TARGET="TRLX_Middle" TITLE="About Tracheostomy"><U><B> endotracheal incubation</B></U></A></div> <div> <A HREF="id44.htm" TARGET="_top" TITLE="Care of the Tracheostomy"><U><B>Care of the tracheostomy</B></U></A></div> <div> <A HREF="id37.htm" TARGET="_top" TITLE="Tracheostomy Feeding"><U><B>Tracheostomy & Feeding</B></U></A></div> <div> <A HREF="id46.htm" TARGET="_top" TITLE="Suctioning the Trachy"><U><B>Suctioning the trachy</B></U></A></div> <div> <A HREF="id43.htm" TARGET="_top" TITLE="Decanulation"><U><B>Decannulation</B></U></A></div> <bR> <bR> <bR> </td> <td valign="top" BGCOLOR="#FF9900" TEXT="#080000" bgproperties="fixed" background="10e00c82dwnjbj.jpg"> <div> <FONT SIZE="5" COLOR="#FFCC33" FACE="Bradley Hand ITC" ><B> <A NAME="top"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>TSNI</B></FONT><FONT SIZE="1" COLOR="#FFCC33" FACE="Arial" >  </FONT><FONT SIZE="1" COLOR="#333399" FACE="Arial" >  |    </FONT> <A HREF="index.htm" TARGET="_top" TITLE="TSNI"><U>home</U></A>        <FONT SIZE="1" COLOR="#333399" FACE="Arial" >                                                                                                                                       <IMG SRC="087a14d0.png" border=0 width="161" height="77" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT></div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="About Us"><U>About Us</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="Childrens Profiles"><U>Childrens Profiles</U></A>   |   <B>About Tracheostomy</B>   |   <A HREF="id57.htm" TARGET="_top" TITLE="Subglottic Stenosis"><U>Subglottic Stenosis</U></A>   |   <A HREF="id59.htm" TARGET="_top" TITLE="Passy Muir"><U>Passy Muir</U></A>   |   <A HREF="id60.htm" TARGET="_top" TITLE="Safety Precautions"><U>Safety Precautions</U></A>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Decanulation"><U>Decanulation</U></A>   |   <A HREF="id50.htm" TARGET="_top" TITLE="Going Home"><U>Going Home</U></A>   |   <A HREF="id58.htm" TARGET="_top" TITLE="Help at home"><U>Help at home</U></A>   |   <A HREF="id49.htm" TARGET="_top" TITLE="The First Week"><U>The First Week</U></A>   |   <A HREF="id51.htm" TARGET="_top" TITLE="EMERGENCY"><U>EMERGENCY</U></A>   |   <A HREF="id52.htm" TARGET="_top" TITLE="Makaton"><U>Makaton</U></A>   |   <A HREF="id54.htm" TARGET="_top" TITLE="Premi Page"><U>Premi Page</U></A>   |   <A HREF="id55.htm" TARGET="_top" TITLE="MRSA "><U>MRSA </U></A>   |   <A HREF="id61.htm" TARGET="_top" TITLE="QA"><U>Q&A</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Events"><U>Events</U></A>   |   <A HREF="id38.htm" TARGET="_top" TITLE="TSNI Forum"><U>TSNI Forum</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Live Chat"><U>Live Chat</U></A>   |   <A HREF="id47.htm" TARGET="_top" TITLE="Useful Links Contacts"><U>Useful Links & Contacts</U></A>   |   <A HREF="id48.htm" TARGET="_top" TITLE="Glossary"><U>Glossary</U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A>   |   <A HREF="id56.htm" TARGET="_top" TITLE="Acknowledgements"><U>Acknowledgements</U></A></div> <div> About Tracheostomy</div> <div>  <A NAME="what_is_trach__1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="3" COLOR="#000000" FACE="Century Gothic" >A tracheostomy is an artificial opening into the windpipe (trachea) which is held open by a tracheostomy tube. This helps your child to breathe more easily. Air now goes in and out through the tracheostomy tube and bypasses the nose and mouth. The decision to perform a tracheostomy will have been reached as a result of investigations and tests. There are a variety of reasons why a child may need a tracheostomy, ranging from a narrow airway to the need for long term mechanical respiratory support from, for example, a ventilator.</FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="504" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 ><NOBR><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="23" HSPACE="0" VSPACE="0"></NOBR></tD> <tD VALIGN=TOP WIDTH="223"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="223" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="248"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="248" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> The indications for tracheostomy include:</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">prolonged intubation during the course of a critical illness </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">subglottic stenosis from prior trauma </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">obstruction from obesity for sleep apnea </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">congenital (inherited) abnormality of the larynx or trachea </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">severe neck or mouth injuries </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">inhalation of corrosive material smoke or steam </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">presence of a large foreign body that occludes the airway </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">paralysis of the muscles that affect swallowing causing a danger of aspiration </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">long term unconsciousness or coma </div> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="049ae840.gif" border=0 width="430" height="388" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <div> <B><IMG SRC="0dd90400.jpg" border=0 width="400" height="320" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B><B><IMG SRC="0dc90400.jpg" border=0 width="400" height="320" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <bR> <div> <IMG SRC="0df90400.jpg" border=0 width="400" height="320" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B> <A NAME="meet_the_team"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><FONT SIZE="3" COLOR="#FF0000" FACE="Century" ><B>Meet the team</B></FONT></div> <bR> <div> There may seem to be a great many people looking after your child while you are in hospital and after you return home. Some people you will meet include:</div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tracheostomy nurse specialist:</B> she will probably be your first port of call for any questions you have and will be the main person training you to care for your child’s tracheostomy. </div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Ward nurses:</B> they will be responsible for your child’s day-to-day care and for teaching you to look after your childs tracheostomy. </div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Play specialist: </B>who will help you to prepare your child for the operation. He or she will show your child a photo book of children who already have a tracheostomy and maybe a special doll who also has a tracheostomy. </div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Speech and language therapists:</B> they will work with you in managing your child’s communication development and help if there are any difficulties in swallowing.</div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Social worker:</B> they are available to see any family who needs support or a listening ear. They can also offer help and advice about benefits and other services, financial help, planning for going home and liaising with your local social services department, and what help might be available to you when your child is discharged.</div> <bR> <div> Remember that all the team are here to help you and will always be on the end of a telephone if you need help and advice. Once you get home, you will have the support of your community team which will include your health visitor or community paediatric nurse and your GP. </div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="About Tracheostomy"><U>Top</U></A>]</div> <bR> <div>  <A NAME="hospstay"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Y</B><B>our hospital stay</B></div> <bR> <div> Your child’s surgeon will explain the operation in detail, discuss any worries you may have, and ask you to sign a consent form. The operation will be carried out under a general anaesthetic. </div> <bR> <div> Your child will stay in hospital for a minimum of two weeks after the operation. This is so that you can learn the necessary skills to care for your child’s tracheostomy at home. This may seem a daunting prospect at this stage but you will be supported throughout your stay. You may be discharged straight home or via your local hospital.</div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="About Tracheostomy"><U>Top</U></A>]</div> <bR> <div>  <A NAME="backtheatre"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="3" COLOR="#FF0000" FACE="Century Gothic" ><B>Back from theatre</B></FONT></div> <bR> <div> After the operation, your child will return to the ward with a suitably sized tracheostomy tube, held in place with cotton tapes and temporary stay sutures. Stay sutures are long stitches, brought out through the wound and taped down onto your child’s chest. These sutures keep the hole open if the tube has to be changed early.</div> <div> After the operation, your child will not be allowed any food or drink (whether by mouth or feeding tube) for a minimum of three hours until the anaesthetic wears off. After this, your child will be allowed to have his or her normal diet. Occasionally some children experience difficulties with their swallowing. This is normally a temporary problem that resolves itself. If it does persist, a speech and language therapist may help in assessing and managing his or her swallowing abilities.</div> <bR> <div> During the two weeks after the operation, you can expect the following events. This is a rough guide, so do not worry if things do not always go to plan.</div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="About Tracheostomy"><U>Top</U></A>]</div> <bR> <div> <B>Indications for tracheostomy</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">To relieve upper airway obstruction </B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Foreign body </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Trauma </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Acute infection - acute epiglottitis, diphtheria </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Glottic oedema </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Bilateral abductor paralysis of the vocal cords </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tumours of the larynx </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Congenital web or atresia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">To improve respiratory function </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Fulminating bronchopneumonia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Chronic bronchitis and emphysema </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Chest injury and flail chest </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Respiratory paralysis </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Unconscious head injury </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Bulbar poliomyelitis </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tetanus </div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="About Tracheostomy"><U>Top</U></A>]</div> <bR> <div> <B> <A NAME="advantages_of_tracheostomy_over"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Advantages of tracheostomy over endotracheal intu</B><B>ba</B><B>tion</B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Reduces patient discomfort </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Reduces need for sedation </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Improves ability to maintain oral and bronchial hygiene </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Reduces risk of glottic trauma </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Reduces dead space and reduces work of breathing </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Augments process of weaning from ventilatory support </div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="About Tracheostomy"><U>Top</U></A>]</div> <div> <B>Tracheostomy technique</B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Patient positioned supine with sandbag between scapulae </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Transverse cervical skin incision 1 cm above sternal notch </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Incision should extend to the sternomastoid muscles </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Dissect through fascial planes and retract anterior jugular veins </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Retract the strap muscles </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Divide thyroid isthmus and oversew to prevent bleeding </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Place cricoid hook on 2nd tracheal ring </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Stoma fashioned between 3rd and 4th tracheal rings </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Anterior portion of tracheal ring removed </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">No advantage in creating a tracheal flap </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Endo-tracheal tube withdrawn to sub-glottis </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tracheostomy tube inserted using obturator </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">When confirmed that in correct position the ET tube removed </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tube secured with tapes </div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="About Tracheostomy"><U>Top</U></A>]</div> <div> <B>Complications o</B><B>f tracheos</B><B>tom</B><B>y</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Immediate</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Haemorrhage </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Surgical trauma - oesophagus, recurrent laryngeal nerve </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Pneumothorax </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Intermediate</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tracheal erosion </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tube displacement </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tube obstruction </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Subcutaneous emphysema </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Aspiration & lung abscess </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Late</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Persistent tracheo-cutaneous fistula </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Laryngeal and tracheal stenosis </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tracheomalacia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tracheo-oesophageal fistula </div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="About Tracheostomy"><U>Top</U></A>]</div> <div> <B>Post-operative tracheostomy care</B></div> <bR> <div> <I><B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Maintain patent airway </B></I></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Frequent atraumatic suction </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Humidification of inspired air and oxygen </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Mucolytic agents </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Coughing and physiotherapy </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Occasional bronchial lavage </div> <bR> <div> <I><B><IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">P</B></I><I><B>revent infection and complications</B></I><I><B> </B></I></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Aseptic tube suction, handling and tube changing </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Prophylactic antibiotics </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Deflate cuff for 5 minutes every hours </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Avoid tube impinging on posterior tracheal wall </div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="About Tracheostomy"><U>Top</U></A>]</div> <div> <B>Percutaneous tracheostomy</B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Indicated in patients likely to require ventilatory support for more than 2 weeks </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Usually performed at the bedside in an ITU </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Has significant cost benefits compared to open procedure </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Performed using a guide-wire and dilators </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Bronchoscopic guidance may reduce the complication rate </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">May be associated with a reduced risk of bleeding and infection </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Success rates of 98% have been reported </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Mortality related to the procedure is less than 0.5% </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Complications occur in 5-15% of patients </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Complications are similar to those following the open procedure </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Re-insertion of a displaced tube may be more difficult </div> <DIV ALIGN="LEFT"></DIV> <div> [<A HREF="#top" TITLE="About Tracheostomy"><U>Top</U></A>]</div> <bR> <bR> <bR> <bR> </td> </tr></table></body>