Throat surgery when to pick up the tube. What is a tracheostomy: care, photo. Is there a risk of stroke?

Today, no one doubts that to ensure the patency of the upper respiratory tract, the most effective method is tracheal intubation, but centuries passed before the first attempts were transformed into an effective technique.

In 1788, London physician Charles Keith designed a bent metal endotracheal tube (tracheostomy) for adults and reported on oro- and nasotracheal intubation. In addition, Ch. Keete described and recommended for use the technique of pressing the larynx to the spine while blowing air to reduce entry into the stomach.

Only almost 200 years later, this technique was re-introduced by Brian Selick and recommended for widespread use to prevent regurgitation before tracheal intubation.

What is it and why

Tracheostomy or cannula from Greek windpipe, is carried out by doing holes in the larynx and placing a special tubes. They come in metal and plastic, the former are more often used for constant wear, the latter for long-term, but not constant wear, they are more often used abroad, therefore they are considered better, but both of them are rarely available in city pharmacies, for example, they ordered it for me in Moscow .

Performing a tracheostomy

The first mention of tracheostomy was found in ancient Egyptian papyri. There is evidence that Alexander the Great used a sword to make a hole in the larynx of his soldiers who were choking on a bone. More or less reliable references indicate that it was carried out by Asklepiades 100 years BC.

During the Renaissance, tracheostomy in animals was described by Vesalius in 1543. In 1788, Antoine Portal proposed tracheostomy as a last resort when it was impossible to perform artificial ventilation of the lungs (ALV) through the mouth. Only since the 30s. tracheostomy came into practice as a method of performing planned mechanical ventilation.

Purpose of installation

Tracheostomy surgery can be upper, middle and lower. Adults are more often treated with the upper one, children with the lower one (due to the different location thyroid gland), the middle incision is made extremely rarely, in case of special anatomical features trachea.

The tube is placed urgently in cases where:

• it is not possible to remove a foreign object from the throat;
• angioedema;
• laryngeal injury;
• traumatic brain injury;
• when a person is unconscious and cannot breathe on his own.

A tracheostomy is not placed urgently when special cases tonsillitis, laryngeal stenosis and throat cancer.

For what period is it placed?

After a relatively minor stroke or brain injury, if a tracheostomy was required, after acute period the hole (stoma) is stitched up on average up to a month, sometimes even after a couple of days.

Most likely, a person will not need to close the wound - after this period, the skin on the neck will heal itself, naturally, only after removing the tube from the hole.

IN severe cases when the cannula is left in place for a long time, the stoma becomes overgrown, or it is sutured within several months.

In extremely severe cases, when there is choking and the inability to breathe through the nose (the hole in the neck will no longer close on its own), it is stitched up when the injured person is able to perform these actions. After throat cancer, for example, when the entire trachea is cut out, the tube remains in place for life.

Living with a cannula is certainly not comfortable, especially at first. For example, I had to live with it for 2 years, and after removing it for another 2 years with a hole until my respiratory and swallowing functions improved.

If we can still somehow restore motor functions with exercises, then for normal operation Only time will help the respiratory and swallowing system; there are, however, some exercises for training these muscles (blowing air through a straw into a glass of water, inflating balloons and breathing exercises), but they will only be useful for strengthening the lungs.

Rules for living with a pipe

A person with a tracheostomy in the larynx needs special care - it is important to prevent it, it is necessary to purchase a tracheostomy for sanitation - costs from 6,000 rubles. to order, it is needed to remove sputum (saliva) from the lungs, a person must sleep carefully on his side so as not to accidentally close the cannula hole and suffocate, wash carefully so that water does not get into the lungs.

It is necessary to change the tube for a new one at least once every two weeks - more often is better; in a hospital, this is usually done in the operating room because it is not known how the body will behave if left without it.

It is advisable to change the ribbon - the ribbon with which it is held on the neck every day, the bandage gasket between the hole and the “wings” should be changed as soon as the bandage gets wet or dirty, you also need to take care of the skin, lubricate the skin area around the incision for disinfection with a 3% peroxide solution hydrogen. For whole body hygiene use

Some people have probably seen people with a tube in their throat. Medically speaking, he had a tracheostomy installed. What is it, why is it necessary and how to live with such a device - all questions should be answered by a doctor. After all, only a specialist can explain in detail the essence and features of medical technology.

A tracheostomy, as one can judge from the term itself, is an artificial windpipe. This is an opening in the larynx formed surgically to ensure respiratory function, into which a special cannula is inserted. The latter becomes the breathing tube in the throat that people pay attention to. It is necessary for the unhindered passage of air into the trachea.

Indications

Breathing is the most important function that supports the functioning of the body. If there is some kind of obstruction to air flow in the upper respiratory tract, then all systems suffer. The body does not receive enough oxygen, which leads to hypoxia and metabolic disorders. This negatively affects many processes and functions, leads to morphological disorders, and in some cases is fraught with death.

Based on the above, it is extremely important to restore full breathing. The conditions under which a tube is inserted into the throat are very diverse. Their main feature is obstruction (blockage) of the lumen at the level of the larynx or pharynx, which occurs in the following situations:

• Foreign bodies.
• Diphtheria.
• Quincke's edema.
• Subglottic laryngitis.
• Laryngeal sore throat.
• Chondroperichondritis.
• Burns and injuries.
• Scars or tumors.

Airway obstruction can be acute, subacute or chronic, depending on the rate of development of respiratory disorders. A tube in the throat is also placed after surgery involving removal of the larynx, or in cases where long-term artificial ventilation is performed. This measure is a necessity that allows the patient to maintain respiratory function.

People have to wear a tube in their larynx various reasons. Without it, it will be difficult or even impossible for them to breathe.

Carrying out the operation

The operation of placing an artificial breathing hole is called tracheostomy. Based on the indications, the manipulation is performed urgently or as planned. After local anesthesia, the surgeon cuts the skin and underlying tissue along the front wall of the neck. Next, the trachea is dissected in a place corresponding to the localization of the pathology. Taking this into account, there are several options for tracheostomy:

• The top one.
• The middle one.
• Bottom.

The incision is made transversely to the trachea, longitudinally (through several rings) or U-shaped. The doctor decides how to carry it out during the operation. If the cannula will be worn for a long time, then the mucous membrane of the trachea is first sutured to the skin. With more short term they don't do this. When the tube is removed for a period of more than 2–3 days, the hole collapses and closes.

There are also cannula-free methods, when the tracheostomy is left open. In this case, a fibrous ring is formed around it, preventing the artificial hole from collapsing. However, if the patient has softening cartilage tissue(chondromalacia) it is impossible to use such a technique.

Cannula device

The tracheostomy cannula is produced in several versions. There are metal tubes and plastic ones. The latter are made of thermoplastic material that becomes elastic at body temperature. They are good for long-term wearing, since they have minimal impact on surrounding tissues. Metal ones are mainly used in urgent situations when it is necessary to quickly restore airway patency.

At the outer end of the cannula there is a structure resembling butterfly wings. Its purpose is to protect the edges of the tracheostomy opening from aggressive factors environment. And at the inner end of some tubes there may be inflating balloons (cuffs). They fix the cannula in the lumen of the trachea, ensure the tightness of the connection, and also prevent saliva and mucus from flowing into the airways.

Separate tubes are also equipped with a system for removing mucus from the space located above the cuff. This must be done before deflating the balloon. Another feature of some cannulas is the phonation window, which is an opening at the top of the bend of the tube. When it is necessary to use the speech function, the patient covers the tracheostomy with his finger, and air enters the vocal cords.

The tube is installed during surgical intervention, during which a hole is formed in the anterior wall of the trachea.

Tracheostomy care

People who have a tube inserted down their throat face a number of unpleasant experiences. The cannula is a foreign body to the body and constantly irritates the mucous membrane of the trachea and the skin around the opening. It becomes a source of discomfort painful sensations and cough.

A person who has a tube in their throat must care for the tracheostomy daily. The cannula is removed and washed from mucus using a special brush. For better cleaning, first soak it in a soapy solution. The hole is left without a tube for 1.5 hours, observing its condition. Gradually this time increases to completely dispense with the cannula. In the meantime, this is not possible, the tube is inserted back, pre-lubricated with methyluracil ointment. It is also used to treat the edges of the tracheostomy and the skin around it.

If a patient has a permanent cannula installed, he should not shower, take a bath, or swim. This can lead to water entering the respiratory tract and causing asphyxia. The risk also increases inflammatory lesion respiratory tract, which is why you should limit your stay in conditions with dusty and gassy, ​​cold and dry air. At low ambient temperatures, it is recommended to cover the hole with several layers of gauze to warm the inhaled mixture.

A tracheostomy cannula is placed to restore patency of the respiratory tract when it is blocked at the level of the larynx or pharynx. The tube is inserted into a hole created during surgery and requires constant care. And although it causes a lot of trouble, it returns the body the most important function- respiratory.

07.12.2016

One of the important physiological processes ensuring proper functioning of cells human body, is breathing. Due to sufficient oxygen saturation, oxidative reactions occur.

The chemical element plays an important role in the metabolic processes of tissues and organs. Delayed oxygen supply can lead to irreversible pathological changes.

What is a tracheostomy?

A tracheostomy is an artificial windpipe, which is a special tube that is surgically placed into the trachea.

Products can be made of metal or plastic. Metal tracheostomies are used for long-term, constant wear, plastic tubes are used for periodic use.

A properly installed artificial throat can provide full respiratory function if natural use of the upper respiratory tract is impossible. During the procedure for introducing the product, the closest location of the trachea to the skin in the throat area is determined.

Indications for surgery

The procedure can be performed as planned in medical institution for artificial ventilation of the lungs, or in in case of emergency to save lives.

Indications for tracheostomy are:

• allergic edema (Quincke's edema);
• airway obstruction due to injury or exposure foreign object into the throat;
• tracheal damage;
• TBI (brain injury);
• stroke;
• laryngeal stenosis;
• severe forms of sore throat;
• throat cancer

Performing a tracheostomy

Blockage can be predicted when chronic inflammation, throat cancer, or sudden. In case of passing acute phase disease, normalization of the patient’s condition who required the installation of a tracheostomy, the tube is removed and the hole is sutured.

There are several types of surgery procedures:

• lower (performed on children due to the location of the thyroid gland);
• medium (rarely used, in the presence of specific anatomy of the larynx);
• upper (used for adult patients).

Severe illnesses and the inability to breathe independently will require prolonged wearing of the product until natural respiratory processes are restored. Lifelong wearing of an artificial throat is used for complete removal trachea after suffering from throat cancer.

The tracheostomy operation, even in a medical facility, is a complex surgical procedure and is performed in a certain sequence. After the procedure, you may experience Various types complications that require urgent elimination.

In the early postoperative period, it is important to prevent blood from entering the tracheal opening to avoid the formation of blood clots in this area. The occurrence of subcutaneous emphysema can be caused by the combination of the respiratory cavities with the subcutaneous tissue.

Focal suppuration can cause serious inflammatory processes, so it is especially important to carry out timely antiseptic treatment and care.

Restoration of respiratory function

A tracheostomy can cause physical and aesthetic discomfort when placed in the throat. After prolonged and constant wearing, it will take quite a long time for swallowing and respiratory functions to normalize.

Carrying out simple exercises for muscle training will help strengthen the lungs, speed up adaptation and recovery. It is recommended to regularly perform special gymnastic exercises, inflate balloons and blow air through a straw into a glass of water.

Despite the effectiveness of the procedures, the main factor in recovery and healing after surgery is time. After wearing a tracheostomy for two years, it will take the same amount of time to resume natural respiratory processes.

Tracheostomy care

An installed tracheostomy requires special attention and care. Initially, while in a medical facility, the condition of the tube is monitored by specialists. After the formation of the tracheotomy tract is completed, the patient will be able to independently care for the artificial throat.

Products come various types and sizes. A cannula-type tracheostomy is equipped with a special tube. There are also cannulaless options.

Proper care will allow the patient to avoid discomfort and all kinds of complications. The opening in the trachea will stop narrowing over time. A fully formed lumen is an indication for removing the cannula from the tracheostomy.

The product care process includes:

• timely daily cleaning and removal of the tube from the stoma;
• thorough rinsing of mucus and crusts in a special solution;
• wiping medical alcohol using a sterile wipe;
• lubricating the outer surface of the tube with glycerin;
• Carefully insert the cannula into the stoma with a light screwing motion.

While the patient is in the hospital, the attending physician may refuse to insert the tube, observing the position of the lumen. The first signs of narrowing of the hole are an indication to return the cannula to the tracheostomy.

Before the procedure, the skin around the lumen area, the tube and the edges of the stoma are pre-treated with a special ointment.

Features of the procedures

It is equally important to sanitize the respiratory tract and provide proper care for the opening in the trachea. Sputum is removed using a special device - a medical sonator.

The frequency of the procedure is determined individually. The patient should breathe freely and normally.

Indications for sanitation are:

• specific sound of gulping from the cannula;
• restless behavior, patient discomfort;
• visible discharge of phlegm or saliva.

The patient is advised to sleep in a lateral decubitus position to avoid the possibility of accidental closure of the tracheostomy opening. Water procedures should also be carried out with extreme caution, eliminating the possibility of water entering the respiratory system.

The tape that secures the product is replaced daily. The gasket between the hole and the tracheostomy is changed without delay when it gets wet or dirty.

It is important to ensure careful care of the skin of the neck in the area around the stoma, carrying out systematic disinfection using a hydrogen peroxide solution. Body hygiene of patients after trachostomy is performed using special means, which do not require subsequent rinsing.

A temporary or permanent tracheostomy will require taking restrictions seriously and strictly following the rules for this type of patient. Your usual lifestyle will need to be changed in accordance with the recommendations of your doctor.

Ignoring the established rules can lead to respiratory arrest, blockage of the passages and the occurrence of inflammatory processes in the tracheostomy area.

Main dangers to avoid:

• walking in windy, hot or cold weather;
• accumulation of mucus and sputum in the tube;
• being in dusty, gassy places;
• sleeping on your stomach;
• diving, showering, swimming.

They will help make the patient’s life easier after tracheostomy. useful tips and recommendations:

1. Restoration of respiratory, swallowing, motor functions It will be much easier and painless when you perform special gymnastic exercises.
2. Specific noise and wheezing indicate the need to clean the cannula.
3. Eating should take place in a calm environment. During this, the patient should not laugh or talk.
4. In extreme cold, the stoma should be covered with a thick gauze bandage, avoiding deep breaths.
5. Dry or hot weather will require periodic moistening of the gauze.
6. It is important to carry out daily, thorough oral care, which will prevent the development of complications and all kinds of inflammatory processes.
7. The use of special inhalers will alleviate the condition, eliminate irritation of the mucous membrane, providing a moisturizing effect.
8. It is recommended to install air humidifiers in the room where the patient is most frequently used, which will precipitate or eliminate dust particles from the air.
9. Aesthetic comfort when wearing a tracheostomy can be achieved by wearing a tie or neckerchief, or a light scarf.

For the first time after surgery, the patient will not be able to talk. Until functions are restored, you can use a regular notepad or smartphone to communicate or describe the condition.

There are also tracheostomies with a special phonation window that allow sonorous speech when the cannula outlet is closed, raising the air flow to the vocal cords.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Breathing is one of the most important life support processes, for which air must pass through nasal cavity, larynx and trachea, however, if the patency of the upper respiratory tract is impaired, it can be disrupted, and then breathing will become impossible. Acute obstructions occur at the most various reasons, and the doctor sometimes has only a few minutes at his disposal, during which he needs to take correct solution and take active action.

Tracheostomy is performed to restore air flow into the trachea, it is classified as a life-saving operation, and most often it is performed urgently in case of acute blockage of the respiratory tract. The operation consists of opening the lumen of the trachea and placing a special tube (cannula) there through which air flows.

Tracheostomy surgery can be performed as an outpatient procedure (according to vital signs), and in the hospital - urgently or planned. This is a complex procedure that involves high risk complications, and it is not always successful even with the surgeon’s impeccable technique due to the initial severity of the patient’s condition.

Despite the high risk, the trachea is still opened, because a person’s life is at stake. General anesthesia is considered the optimal method of pain relief, but if it is not possible, local anesthesia is used. Insufficient pain relief may cause unfavorable outcome, although in emergency cases the surgeon may sacrifice the patient’s sensations in order to save his life. There are cases where tracheostomy was performed without anesthesia at all, but it was possible to improve breathing and bring the patient back to life.

Tracheostomy should be performed by a specialist who has the skills of this manipulation and has all the necessary necessary tools. If there are no such conditions (for example, in public place, on the street), then the doctor will perform a conicotomy, and after the patient is delivered to the hospital, a tracheostomy will be performed in safer conditions.

Video: tracheostomy - medical animation

Indications and contraindications for tracheostomy

The reason for tracheostomy is considered to be a breathing disorder in which air cannot enter the trachea through the overlying sections. Respiratory distress can be lightning fast, when asphyxia increases in seconds, acute, when it comes to minutes. Subacute airway obstruction develops over several hours, while chronic obstruction develops over a long period of time, over days, months and even years.

Airway obstruction and asphyxia occur when:

All of the above conditions are considered indications for tracheostomy, which, depending on the specific cause, will be emergency, urgent or planned, performed in inpatient conditions patients with chronic respiratory dysfunction.

Children have the most common reasons that require tracheotomy are foreign bodies, blocking the larynx or trachea, allergic reactions, as well as acute inflammatory processes– croup in the background viral infection, diphtheria. Children younger age are more at risk of asphyxia due to the narrowness of the airway system, so any inflammation in the larynx and subglottic space should be under close medical supervision.

In adults, the reason for opening the trachea can be both foreign bodies and severe injuries, in old age, tumors obstructing the airways are likely, as well as chronic pulmonary pathology, suggesting a long artificial ventilation lungs.

First aid outside medical institution for asphyxia it is considered, that is, dissection of the ligament between the thyroid and cricoid cartilage. This procedure is technically simpler and safer, but cannot provide a long-term effect, so after transportation to the hospital a tracheostomy is performed.

It seems to many that cutting the trachea to allow air to enter is not so difficult; you just need to position the victim correctly and arm yourself with a cutting object. However, the proximity of large vessels, the thyroid gland, and nerves makes the manipulation quite dangerous in the absence of proper experience. Only a surgeon skilled in conicotomy and tracheostomy can make the incision correctly without damaging vital structures.

I would like to especially warn parents who refuse hospitalization with children diagnosed with croup. Cases have been described, and they are not isolated, when a child died without emergency qualified assistance, and especially desperate parents performed conicotomy themselves. In such cases excessive self-confidence or excessive hopes for recovery without the help of doctors can cost the life of a small patient.

Emergency tracheostomy is indicated for foreign bodies, rapidly increasing edema with stenosis, spasm of the larynx, blockage of its lumen with fibrinous films in diphtheria. Chronic obstruction, developing over months and even several years, is formed due to perichondritis of the larynx (inflammation of cartilage), growing malignant or benign tumor, cicatricial narrowing after burns or injuries.

There are essentially no contraindications to tracheostomy surgery. It will not be performed on a patient in an agonal state because it is inappropriate; all other patients will undergo a tracheostomy, regardless of age, concomitant pathology, or the cause of asphyxia.

Technique and conditions for tracheostomy

A tracheostomy is an operation in which an opening is created in the trachea, into which a special tube or cannula is placed to allow air to pass into the airways. Tracheotomy is a manipulation by which the wall of the trachea is dissected; this is the initial stage of the tracheostomy operation.

The operation of opening the trachea is performed using tracheostomy instruments, which can be found in any operating room. Unlike conicotomy, which more often has to be resorted to outside a medical institution and with the help of improvised means, cutting the trachea with a kitchen knife and placing there whatever comes to hand is fraught with dangerous complications and the death of the patient, so it is better to entrust it to professionals in an operating room where the appropriate tools are available.

surgical technique

Tracheostomy kit includes blood stop clamps, scalpel, tracheal dilators, cannulas different sizes, gloves and dressings, two types of scissors, hooks, tweezers, needles and needle holders, oxygen cushion, aspirator. It is clear that a doctor cannot have such a number of instruments with him in a public place, but intensive care units, operating rooms, and ambulance teams are equipped with them.

Depending on the section of the trachea in which the tracheotomy occurs, it can be upper, middle and lower. The upper one is most often used in adults, the lower one is possible in childhood due to the higher location of the thyroid gland, the median one is the most dangerous for complications, but it is chosen when the first two types are technically impossible. In the direction of the section of the tissues of the neck and trachea, the tracheostomy can be transverse, longitudinal, or U-shaped.

Tracheostomy or tracheotomy surgery requires general anesthesia, but in emergency cases it is enough local anesthesia novocaine solution, which is entered into soft fabrics neck. To enhance the effect of local anesthesia, intravenous sedatives are additionally administered.

An intervention carried out completely without anesthesia sharply reduces the chances of a favorable outcome of the procedure and is practically impossible. For children, tracheostomy is always performed under general anesthesia. The duration of the operation is about 20-30 minutes.

Preparation for surgery is carried out only in case of planned treatment, for chronic and subacute forms airway obstruction; in case of asphyxia, there is simply no time for it. In preparation for tracheostomy, the following may be prescribed:

1. General clinical urine and blood tests;
2. X-ray of the lungs;
3. Coagulogram.

IN mandatory the surgeon evaluates the list of medications taken, especially for anticoagulants (warfarin), aspirin, and antiplatelet agents. About a week before the proposed planned tracheostomy, they are canceled in order to prevent bleeding.

The stages of tracheostomy surgery, regardless of the level of its implementation, include:

• Place the patient in the correct position;
• Dissection of the soft tissues of the neck and trachea;
• Insertion of a tracheostomy cannula into the airway;
• Strengthening the air duct and suturing the skin.

Regardless of the type of operation, the patient is placed on his back, a cushion is placed under the shoulder blades, and the head should be tilted back for better access to the trachea and to prevent injury to other organs. Difficulties arise from injuries cervical region spine, when any movements, and even more so, throwing back the head, are prohibited. In such cases, tracheostomy will be preferred standard procedure intubation as safer.

After immersing the patient in anesthesia, the surgeon treats the surgical field in the usual way, limits it with sterile napkins and begins cutting the soft tissue up or down, depending on the chosen manipulation technique.

upper tracheostomy incision

Upper tracheostomy is carried out by cutting the skin and subcutaneous layer from the thyroid cartilage in a downward direction for 4-6 cm. The cervical muscles are pulled apart with blunt hooks to the sides, the isthmus of the thyroid gland is found above the cricoid cartilage of the larynx, which is retracted downwards. The larynx, which can contract convulsively, is fixed with a sharp hook.

Upon reaching the surface of the trachea, the surgeon takes the scalpel with the blade up, carefully cuts the third (sometimes fourth) cartilage of the trachea, acting very carefully, because large vital vascular trunks pass nearby. When air flow from outside enters the trachea, breathing a short time stops (apnea), then an active cough impulse follows, after which a dilator is inserted into the trachea. A tracheostomy cannula is placed through the resulting hole. the right size. At the end of the manipulation, the dilator is removed and the skin wound is sutured.

At lower tracheostomy the incision starts from the sternal notch and goes vertically up midline neck, its length is approximately 6-8 cm. Then the underlying tissues, the fascia of the neck, are dissected, the jugular venous arch is retracted down with a hook to prevent damage to it with a scalpel, the deep fascia is dissected, and the muscles are retracted to the sides. The tissue in front of the trachea is moved away, the vessels are ligated, thyroid gland shifted upward. Having gained access to 4-5 cartilaginous rings, the surgeon dissects them, pointing the scalpel upward, away from the sternum, so as not to touch large vessels.

After access to the trachea is provided, the surgeon makes sure that the mucous membrane is also opened, otherwise the cannula will be installed in the submucosal layer, and this is a dangerous complication.

The technique of performing upper and lower tracheostomy differs only in the initial stage - the direction of the soft tissue incision. The first option is more often used in adults, lower tracheostomy - in children.

Classic tracheostomy is performed in an operating room and carries great risks. Thus, according to some data, at least a third of patients experience complications after surgery. To reduce the likelihood of complications and ease surgical technique was proposed percutaneous tracheostomy (puncture-dilatation) surgery.

Percutaneous tracheostomy has a number of advantages:

1. Can be performed outside the operating room, at the patient’s bedside;
2. Requires less time than open tracheostomy;
3. Minor surgical trauma, so the risk of bleeding and infection is lower;
4. Good cosmetic result.

Dilational tracheostomy easier to reproduce than the classical method of operation, but an obstacle to its widespread use is most often the high cost of manipulation kits.

Puncture tracheostomy can be performed using dilators of different sizes, sequentially inserted into the trachea, or a special clamp with a conductor (Griggs method).

Percutaneous tracheostomy technique:

• The patient is placed on his back with his head thrown back, with a bolster under his shoulder blades;
• Treating the puncture site with antiseptics;
• A horizontal incision of soft tissues, which are pushed to the sides with blunt hooks, exposing the tracheal rings;
• Insertion of a puncture needle between I and II or II and III cartilaginous rings, placing a flexible conductor in the needle;
• Inserting expanders along the conductor until a hole of the required diameter is formed;
• Placement of a tracheostomy tube into the trachea along with a dilator, removal of the dilator and fixation of the tube.

percutaneous tracheostomy

In the case when a dilatation clamp is used, the surgeon first makes a test puncture under bronchoscopy control, then inserts a thick needle with a cannula, which remains in the lumen of the trachea. A guidewire is inserted through the cannula into the trachea. Next, a small incision is made in the soft tissue with a scalpel, and the hole for the tracheostomy is expanded using a clamp.

If the surgeon has sufficient experience in performing puncture tracheostomy, then he can do it not only with the patient’s head thrown back. In some cases (neck injuries, for example), head movements are prohibited, but breathing is impaired and requires urgent tracheostomy. In such situations, on help will come an experienced surgeon capable of performing surgery under difficult conditions.

After installing the tracheostomy tube, it must be securely fixed, since in the first few days there is a high probability of it coming out of the not yet formed stoma. In addition, it is very important that the sizes of the tube and the hole in the trachea match, otherwise bleeding, rupture of the trachea, or incorrect placement of the tube relative to the tracheal wall are possible.

As you can see, any tracheostomy technique, whether open or percutaneous, is quite complex and requires appropriate skills, instrumentation, sterile conditions and anesthesia, therefore at home and without the participation of an experienced surgeon, its implementation is excluded.

Tracheostomy is a very serious operation and complications are not uncommon. The likelihood of their occurrence depends on the time that has passed since the manipulation and on the qualifications of the surgeon. At open surgery they occur in 30-40% of cases; with puncture tracheostomy this figure is significantly lower - about 3%. Some of the most common adverse effects from tracheostomy include:

1. Bleeding when the arteries of the neck are injured, air embolism when the veins are opened;
2. Infection (probability with open surgery up to 40%);
3. Damage back wall trachea, esophagus;
4. Blood entering the bronchi and resulting in aspiration pneumonia;
5. Subcutaneous emphysema, installation of a tracheostomy in the submucosal layer;
6. Rough scars on the skin of the neck, narrowing of the trachea.

Quite often, complications are caused by a violation of the surgical technique. Possible incorrect installation of the tube, its displacement or loss, blockage, discrepancy between the diameters of the tube and the tracheal incision - if the hole is too large, subcutaneous emphysema will develop, and the tube will move or fall out; if the size of the hole in the trachea is insufficient, there is a risk of cartilage necrosis.

Video: performing tracheostomy in a hospital

Video: emergency tracheostomy

Postoperative period and prognosis

The tracheostomy tube can provide the breathing process for a long time, therefore postoperative period the patient must know how to handle it correctly. First of all, the external opening must be kept clean, dressings should be changed promptly and the stoma should be treated with soap and water. It is good if the air in the room where the patient is located is clean and humidified.

Before going outside, it is better to protect the tracheostomy opening with a scarf to prevent dust and dirt from entering the trachea. Breathe in water, inhale powdered products and remedies with a tube household chemicals may be dangerous.

If you have a tracheostomy, there may be some difficulties with speech, which usually take a few days to overcome. When talking, the tracheostomy opening should be closed.

The prognosis for tracheostomy is always serious. It is associated not only with the complexity of the procedure and the need to adapt to the existence of a hole in the trachea, but also with the original disease, which can be chronic with irreversible consequences.

In all cases where the condition of a patient with a tracheostomy suddenly worsens, the tube falls out or becomes dislodged, signs of inflammation in the respiratory tract, fever, any changes in the site of the skin incision or deterioration in breathing appear, you should immediately consult a doctor.

Video: tracheostomy tube care and change

When breathing, air passes through the nasal cavity, larynx and trachea, but if there are problems with the patency of the upper respiratory tract, the process becomes impossible - without timely help, the person dies. - a surgical intervention that is performed in emergency cases to restore breathing.

Tracheostomy is performed to restore breathing

Indications for surgery

- an operation in which the surgeon opens the lumen of the trachea and installs a cannula for normal air movement. Main indication – serious violations during breathing, asphyxia.

In what cases is tracheostomy performed:

• Availability foreign body– a spasm occurs that disrupts the airway;
• injuries, damage to the neck, scar changes in the tissues of the larynx;
• inflammation of the cartilage of the larynx;
• diphtheria, whooping cough, measles, other severe infectious processes in the upper respiratory tract - the problem often occurs in children, since their larynx is narrow, any swelling can cause breathing problems;
• tumors of different origins, causing narrowing of the larynx;
• Quincke's edema - severe allergic reaction, occurs when taking medications, after an insect bite;
• narrowing of the lumen of the larynx due to acid burns;
• poisoning by poisons, toxic agents, drug overdose;
• respiratory distress due to severe TBI(traumatic brain injuries).

Tracheostomy is indicated if necessary long-term ventilation lungs and weakened breathing. The problem is noted during operations on the heart, lungs, myasthenia gravis, poisoning with potent drugs and barbiturates, when eliminating the consequences of a head injury, severe forms pneumonia.

Most often, respiratory distress is acute or subacute - dangerous condition develops rapidly within a few minutes or hours. In rare cases, the problem develops over a long period of time, over many months.

Preparation for tracheostomy

Preliminary preparation is carried out only when elective surgery, in emergency cases there is simply no time for tests.

Types of diagnostics:

• general clinical analysis of blood and urine;
• coagulogram;
• tests for HIV, syphilis, hepatitis;
• X-rays of light;

Before the operation, the patient informs the surgeon and anesthesiologist about allergies to drugs and talks about all the medications he has taken recently.

One type of operation is lower tracheostomy

The incision during surgery is made longitudinally, transversely, and U-shaped.

Tracheotomy - opening the trachea, restoring air supply to the lungs, after eliminating breathing problems, the cannula is removed and the wound heals. Tracheostomy - after opening, the mucous layer is sutured to the edges of the skin, the hole is not closed, and a permanent tracheostomy is installed.

How is open surgery performed?

The technique of performing the intervention does not depend on the type of operation - the patient is given anesthesia, an incision is made in the in the right place, restore the breathing process.

Stages of surgery:

1. With any type of tracheostomy, the patient lies on his back, a cushion is placed under the shoulder blades so that the head is tilted back slightly.
2. Anesthesia is administered and treatment is carried out surgical field antiseptic solutions, limit the area with pieces of sterile gauze.
3. The incision is made depending on the type of operation chosen.
4. After access to the trachea, a dilator is inserted into the incision.
5. A cannula of the required size is inserted into the hole.
6. The dilator is removed and sutures are placed.

The total duration of the tube installation operation is 20–30 minutes.

Percutaneous tracheostomy

When performing a classic open tracheostomy operation, complications arise in 30% of patients; in order to reduce the number of negative consequences, percutaneous (puncture-dilation) tracheostomy is performed. Advantages - the intervention can be done outside the operating room, directly at the patient’s bedside, a small incision will reduce the risk of negative consequences, and the scar is almost invisible.

Disadvantage of the technique – high price tools.

This intervention can be performed without hospitalization in the operating room.

Operation stages:

1. The patient is placed on his back, a cushion is placed under the shoulder blades, and the surgical field is treated with an antiseptic.
2. A horizontal dissection is made to expose the tracheal rings.
3. A puncture needle with a flexible guide is inserted.
4. A trachea dilator is inserted through the guidewire and a hole of the required diameter is formed.
5. A tracheostomy tube is installed.
6. The dilator is removed and the tube is fixed.

An experienced surgeon performs percutaneous tracheostomy even for neck injuries. The complication rate after this meta-operative intervention is 3%.

Recovery period

After completion of the operation, the patient is transferred to the intensive care unit to recover and recover from anesthesia. After the tube is installed, the person at first feels unusual about breathing, speaking, and eating, but the discomfort disappears within a few days.

When breathing through a tracheostomy, air immediately enters from the trachea into the bronchi and lungs, which leads to frequent drying of the mucous membrane, the appearance of cracks, and the development of inflammatory processes. To avoid this, on outer surface The cannulas install a filter that humidifies and purifies the air.

After being discharged from the hospital, a person should avoid colds– do not visit crowded places, wear gauze bandages, lubricate the nasopharynx antimicrobials, take multivitamin complexes.

Please refrain from visiting after surgery. crowded places and try not to catch a cold

When installing a temporary tube, decannulation of the tracheostomy is carried out only in the department intensive care, after which the patient is under the supervision of a doctor for some time.

At sharp deterioration conditions after surgery, prolapse of the stroma or its displacement, the appearance of fever, symptoms of inflammatory processes in the respiratory system, consult a doctor immediately.

Caring for your tube

The tracheostomy tube facilitates the breathing process and requires proper care– change dressings regularly, wash the stoma with water and laundry soap and a brush, and if it is heavily soiled, use soda or peroxide.

Before going outside, cover your neck with a handkerchief or scarf to prevent dust and dirt from entering the trachea. To make the tube less clogged, lubricate it with a small amount of sterile oil every 2–4 hours. During a call, the hole in the handset must be closed.

Before going outside, the tube should be wrapped and wiped

Change the bandage twice a day, when large allocation mucus - more often. The skin is first cleaned with Betadine or Chlorhexidine, and the area around the wound can be dried with talcum powder.

Dry, polluted air is harmful to a person with a tracheostomy tube.

Possible consequences and complications

Tracheostomy is a serious and complex surgical interventions, complications after its implementation are a common occurrence.

Possible consequences:

• severe bleeding when the integrity of the cervical arteries is violated;
• when the veins are opened, an air embolism occurs;
• wound infection;
• injury to the posterior surface of the trachea, esophagus;
• development aspiration pneumonia when blood enters the bronchi;
• development of subcutaneous emphysema when a tracheostomy is installed in the subcutaneous layer;
• cartilage necrosis.

After removal of the tracheostomy cannula, scars on the skin often remain at the site of the hole, and a narrowing of the trachea is observed.

Contraindications

Since the intervention helps save the patient's life, special contraindications tracheostomy does not. Tracheal resection is not performed only on people in agony due to inappropriateness.

Intubation over safe method get rid of airway blockage

Relative contraindications for elective tracheostomy are heart failure, inflammatory processes at the site of tracheostomy, enlarged thyroid gland; the operation is not performed on children under 1.5 years of age.

For serious injuries of the cervical spine, classical tracheostomy is replaced by intubation, as this is safer for the patient.

Where do they make it and how much does it cost?

IN government institutions Tracheostomy is performed free of charge, urgently or planned.

You can install the tube for a fee in private clinics, average price operations - 22–25 thousand rubles, replacement and removal of a tube in the throat costs 1.2–1.8 thousand rubles.

The operation will restore normal respiratory process

- an operation that restores normal process breathing, most often it is performed for emergency indications. After the cannula is installed, the person relearns how to breathe, speak, eat, and properly care for the tube. A tracheostomy is placed temporarily, and in some cases you have to walk with it for the rest of your life.