Breathing tube in the throat. What is and proper care for a tracheostomy. Breathing tube. In what cases is tracheostomy performed?

07.12.2016

One of the important physiological processes that ensure the proper functioning of the cells of the 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 routinely in a medical facility to provide artificial ventilation, or in emergency situations to save a life.

Indications for tracheostomy are:

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

Performing a tracheostomy

Blockage can be predictable, with chronic inflammation, throat cancer, or sudden. If the acute phase of the disease passes and the patient’s condition, requiring the installation of a tracheostomy, normalizes, 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 when the trachea is completely removed after 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, various types of complications may arise that require urgent attention.

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 to train muscles 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 in 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 with 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 that 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.

Useful tips and recommendations will help make the patient’s life easier after tracheostomy:

Restoring breathing, swallowing, and motor functions will be much easier and painless when performing special gymnastic exercises.
Specific noise and wheezing indicate the need to clean the cannula.
Eating should take place in a calm environment. During this, the patient should not laugh or talk.
In extreme cold, the stoma should be covered with a thick gauze bandage, avoiding deep breaths.
Dry or hot weather will require periodic moistening of the gauze.
It is important to carry out daily, thorough oral care, which will prevent the development of complications and all kinds of inflammatory processes.
The use of special inhalers will alleviate the condition, eliminate irritation of the mucous membrane, providing a moisturizing effect.
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.
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 the nasal cavity, larynx and trachea, but if the upper respiratory tract is obstructed, it can be disrupted, and then breathing will become impossible. Acute obstructions occur for a variety of reasons, and the doctor sometimes has only a few minutes at his disposal, during which he needs to make the right decision 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 either on an outpatient basis (for health reasons) or in a hospital - urgently or planned. This is a complex procedure that carries a high risk of 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 can cause an unfavorable outcome, although in emergency cases the surgeon may sacrifice the patient’s sensations 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 tools at his disposal. If there are no such conditions (for example, in a public place, on the street), then the doctor will perform a conicotomy, and after the patient is taken 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 an inpatient setting for patients with chronic respiratory dysfunction.

In children, the most common reasons requiring tracheotomy are foreign bodies, clogging the larynx or trachea, allergic reactions, as well as acute inflammatory processes - croup against the background of a viral infection, diphtheria. Young children 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 foreign bodies and severe injuries; in old age, tumors obstructing the airways are likely, as well as chronic pulmonary pathology, which requires prolonged artificial ventilation.

The first aid outside a medical institution for asphyxia is considered to be 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 the cartilage), a 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 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 whatever comes to hand there 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

The tracheostomy kit includes clamps to stop bleeding, a scalpel, tracheal dilators, cannulas of different sizes, gloves and dressings, two types of scissors, hooks, tweezers, needles and needle holders, an oxygen bag, and an 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 middle one is the most dangerous for complications, but it is chosen when the first two types are technically impossible to implement. 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, local anesthesia with a solution of novocaine is sufficient, which is injected into the soft tissues of the 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, in chronic and subacute forms of airway obstruction, in the case of asphyxia, there is simply no time for it. In preparation for tracheostomy, the following may be prescribed:

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

The surgeon must evaluate 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 with injuries to the cervical spine, when any movement, and even more so, throwing back the head, is prohibited. In such cases, tracheostomies will be preferred to the standard intubation procedure as it is 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 an air flow from outside enters the trachea, breathing stops for a short time (apnea), followed by an active cough impulse, after which a dilator is inserted into the trachea. A tracheostomy cannula of the required size is placed through the resulting hole. At the end of the manipulation, the dilator is removed and the skin wound is sutured.

At lower tracheostomy the incision starts from the notch of the sternum, goes vertically up the midline of the 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 its damage 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, and the thyroid gland is 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 facilitate surgical technique, it has been proposed percutaneous tracheostomy (puncture-dilatation) surgery.

Percutaneous tracheostomy has a number of advantages:

Can be performed outside the operating room, at the patient’s bedside;
Requires less time than open tracheostomy;
Minor surgical trauma, so the risk of bleeding and infection is lower;
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;
Inserting a puncture needle between I and II or II and III cartilaginous rings, placing a flexible guide into 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, an experienced surgeon will come to the rescue, capable of performing an operation in 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. With 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:

Bleeding when the arteries of the neck are injured, air embolism when the veins are opened;
Infection (probability with open surgery up to 40%);
Damage to the posterior wall of the trachea, esophagus;
Blood entering the bronchi and resulting in aspiration pneumonia;
Subcutaneous emphysema, installation of a tracheostomy in the submucosal layer;
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

A tracheostomy tube can provide breathing for a long time, so in the 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. Breathing in water, inhaling powdered products or household chemicals through a snorkel can 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

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To teach your patient and their loved ones how to properly care for a tracheostomy tube at home, you first need to explain to them all the procedures. It is also desirable that the transition from hospital to home conditions be as painless as possible. During the learning process, use the patient-specific instructions below as aids.

Understanding the principles of operation of a tracheostomy tube

The doctor creates a tracheostomy, a small opening or stoma in your throat.

The tube inserted into the tracheostomy makes breathing easier because the tube always keeps the airways open. A tracheostomy tube, or tracheal tube for short, consists of three parts:
- internal cannula;
- external cannula;
- obturbator.

The inner cannula fits into the outer cannula, which is inserted along with the obturbator.

A tracheostomy tube has an external tracheostomy plate that helps secure the tube in place. Tracheostomy straps are threaded through holes in the tracheostomy plate to ensure that the tube is in constant position. The tracheostomy tube also has an inner cuff that, when inflated, helps keep the tube in a fixed position and prevents food, fluids, and secretions from entering the lungs.

Explain to the patient that before starting to care for the tracheostomy tube, he only needs to thoroughly wash his hands. However, if care is provided by family members, they not only need to wash their hands, but also wear gloves.

How to clean the inner cannula

To prevent infection, remove and clean the inner cannula regularly as directed by your healthcare professional.

1. Place the following items near the sink:
* small kidney-shaped basin filled with water;
* a small brush (Note: A special tracheostomy tube brush can be purchased at medical supply stores or pharmacies. However, small brushes designed for cleaning coffee pots can perform the same function. They are inexpensive and can be purchased at regular hardware stores. Keep an eye out ensure that this brush is used exclusively for cleaning the tracheostomy tube.)
* liquid dishwashing detergent (weak);
* gauze pad;
* scissors;
* clean tracheostomy tapes (twill insulating tape)

You can also use a special kit containing all the necessary accessories.

2. Pour liquid dishwashing detergent into a bowl filled with water.

3. Prepare new tracheostomy straps.

4. Place the mirror in such a position that it is convenient to see your face and larynx.

5. Wash your hands.

6. While sitting or standing in front of a mirror, open the inner cannula by turning the outside of the inner cannula counterclockwise.

7. Remove the cannula by evenly pushing it outward and downward.

If you start coughing, cover your stoma with a cloth, bend forward and rest until the cough stops.

8. Then clean the dirty cannula. To do this, immerse the cannula in water with a cleaning solution, then clean it with a small brush. If the contamination is too severe, place the cannula in a hydrogen peroxide solution. You will see foam that forms as a result of the reaction of the solution with the secretions covering the cannula. Once the foam has disappeared, clean the cannula with a brush.

9. Then rinse the inner cannula with running water. Be sure to thoroughly rinse off all cleaning solutions. Shake off any remaining water from the cannula, but do not dry it completely, as the remaining drops of water act as a lubricant to make re-insertion of the cannula easier.

10. Reinsert the clean cannula. Place it in place by turning the outside of the inner cannula clockwise. (Note: If you wish, you can set aside the dirty cannula and clean it later, but use a previously prepared clean cannula for now.)

11. Replace dirty ribbons with new ones. Do not remove the old straps until you are sure that the new straps are secure.

12. Tie the ribbons in a straight knot at the back of the neck. Leave enough space so that they do not interfere with breathing. Ideally, two fingers should be placed between the knot and the back of the neck.

13. Untie or carefully cut the soiled ribbons.

14. If necessary, place a gauze pad under the tracheostomy plate.

How to reinsert a tracheostomy tube

Let's say you accidentally cough up your tracheostomy tube. It's OK. If the tracheostomy tube is not dirty, you can reinsert it. Otherwise, use a spare tracheostomy tube.

Follow these instructions to reinsert the tube:
1. Remove the inner cannula from the dislocated tracheostomy tube.
2. If necessary, deflate the cuff by attaching a rubber balloon to the cuff release valve and pump out all the air from the cuff.
3. Insert the obturator into the outer cannula.
4. Then reinsert the tracheostomy tube into the stoma, moving the cannula downward at a slight angle.

6. After this, insert the inner cannula into the tracheostomy tube.
7. Secure it in place by turning the outer side of the inner cannula clockwise. It is likely that you will cough or gag during this procedure, so be sure to securely attach the tracheostomy plate.
8. Using a syringe, inflate the cuff with air in accordance with the instructions of the attending physician. The air-filled cuff can protect the tube from accidental re-displacement.
9. Once you have inflated the cuff, tie the tracheostomy straps and place a gauze pad under the tracheostomy plate.

How to suction a tracheostomy

You suction the tracheostomy to remove secretions that have accumulated in it. Use the following guidelines to help you remember the sequence of procedures.

1. Keep the necessary equipment ready:
- suction device;
- connecting tubes;
- pelvis;
- distilled water;
- catheter for suction.

In case of malfunctions in the device or a power outage, always keep a syringe with a can at the ready.

Wash your hands thoroughly. Then fill a basin with distilled water and place it nearby.

2. Turn on the suction device and adjust the regulator scale to the desired level. As a rule, the division should be between 80 and 120 mmHg, without exceeding 120 mmHg.
3. Remove the suction catheter from its packaging or sealed container.

5. Immerse the free end of the catheter in distilled water, which can facilitate the sliding of the catheter.
6. Take several deep breaths and carefully insert a moistened catheter through the tracheostomy tube or stoma into the trachea (5-8 inches) until you feel resistance.

Caution: Be careful not to get hurt. While inserting the catheter, try to keep the catheter opening open. The pressure generated by suction can damage tissue adjacent to the trachea.

7. Use your thumb to periodically open and close the catheter opening as you begin or end suctioning. As you complete this procedure, carefully remove the catheter from the trachea by rolling it between your thumb and index finger. All this should not take more than 10 seconds. Otherwise, oxygen may leak from the lungs.

8. To rinse the catheter and connecting tube, place the tip of the catheter in distilled water. Then turn off the suction device and disconnect the catheter from the connecting tube. Dispose of the disposable catheter in a plastic trash bin. If you are using a reusable catheter, sterilize it according to the manufacturer's instructions.

Dr. Mark A. Judson and Dr. Steven A. Sun

Today, no one doubts that to ensure 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 the Greek windpipe, is carried out by making 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. For adults, the upper one is more often performed, for children the lower one (due to the different location of the thyroid gland), but the middle incision is made extremely rarely, in the case of special anatomical features of the 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 performed urgently in special cases of tonsillitis, laryngeal stenosis and throat cancer.

For what period is it placed?

After a relatively mild stroke or brain injury, if a tracheostomy is needed, after an acute period the hole (stoma) is sutured 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 only time will help for normal functioning of 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 be useful only to strengthen 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

Content

Breathing is an important life support process for humans. To carry it out, it must pass through the nasal cavity, larynx and trachea. If the airway is obstructed, breathing becomes impossible. The causes for acute obstructions may vary, and doctors usually have little time to solve the problem. In such cases, the patient is fitted with a tube in the throat for breathing - a tracheostomy. It is important for the patient to know about the possible risks and complications after installing the device, the rules of behavior and care of the device.

What is a tracheostomy

If a person cannot breathe fully as a result of an accident or the development of a serious pathology, a tracheostomy cannula, or tracheostomy, is installed. The term is derived from the Latin words: trachea (breathing tube) and stoma (opening). Devices are divided into permanent and temporary. The design is a curved tube made of plastic (for occasional wear) or metal (for long-term use) with wings. The latter are needed to protect peristomal outer tissues from the negative influence of the environment.

The cannula is inserted into the trachea from above or below the isthmus of the thyroid gland. A cannulaless tracheostomy is an opening through which air passes into the lungs. If the device is to be worn for more than 30 days, the edges of the skin are sutured to the tracheal mucosa. For a short period of wearing, a cannula is inserted, the edges of the wound are not sutured. Experts recommend devices for the production of which thermoplastic material is used. At a temperature of 35-38 degrees, they become elastic, which protects the mucous membrane and tissue around the wound from damage.

Indications for tracheostomy

An operation to install a tube into the trachea is performed in patients with disorders of the natural respiratory process. The disorder can develop instantly, or have an acute form, when asphyxia increases within seconds. Subacute airway obstruction develops in patients within a few hours, while chronic airway obstruction appears over weeks, months or years.

Patients often have a tracheostomy installed for stroke and other pathologies that disrupt natural respiratory processes. In addition, the indications for the operation are the following:

entry of foreign bodies into the larynx (against the background of which a spasm of the ligaments develops or mechanical obstacles are created for the passage of air flows into the body);
wounds, injuries in the neck area that caused damage to the respiratory tract;
infections or viral diseases (sore throat, diphtheria, laryngitis, whooping cough, true and false croup, influenza, scleroma, measles, tuberculosis, etc.);
inflammatory processes in the larynx;
Quincke's edema (develops with allergies to insect bites, medications, household chemicals);
laryngeal cancer;
severe traumatic brain injury;
narrowing of the lumen of the larynx (for example, as a result of a chemical burn;
intoxication with toxic substances;
acute laryngeal stenosis of various etiologies;
compression of tracheal rings by aneurysm, struma, inflammatory infiltrates of the neck.

Tracheostomy in children

Breathing disorders can develop in patients of any age. Children require a tracheostomy if a foreign body enters the larynx, allergies, acute inflammatory processes (croup caused by diphtheria and other viral diseases). In babies, asphyxia can be a consequence of narrow airways. Any inflammation of the larynx and subglottic space in young children is important to be monitored by specialists.

Classification of tracheostomies

The operation to install a tracheostomy is carried out in several stages. The first step is to dissect the tissues (skin, subcutaneous tissue) and tracheal wall that hide the anatomical location of the trachea. The further course of the operation depends on the location of the incision. Doctors distinguish the following types:

An upper tracheostomy involves dissecting the tissue above the isthmus of the thyroid gland. This type of operation is the simplest to perform and is used most often than others.
A middle tracheostomy is an incision into the isthmus of the thyroid gland. This option is dangerous, because the organ may be damaged during the operation. Experts choose a medium tracheostomy only in extreme cases when other types are not suitable (for example, for cancerous tumors).
A lower tracheostomy is a dissection of tissue under the isthmus. Due to the anatomical location of the thyroid gland in children above the level of adults, this type of surgery is indicated for patients under 15 years of age.

In addition, there is a classification according to the form of dissection of the tracheal wall. The choice depends on the specific case and is determined after tissue dissection. The following options are available:

longitudinal (from ring to ring);
transverse (between the tracheal rings);
U-shaped tracheotomy.

Stages of the operation

Tracheostomy placement requires general anesthesia. The patient must be in a horizontal position during the operation. Local anesthesia with the use of intravenous sedatives is allowed. Without anesthesia, it is possible to install a tracheostomy only during conicotomy (emergency surgery on the respiratory organs), when there is no time to administer special medications.

The surgical intervention includes several stages. Below is a detailed description of the operation to install a tracheostomy:

The skin and subcutaneous tissue are cut with a scalpel.
Carefully cut through the white line of the neck using tissue scissors “through the light”. This is done to prevent damage to large blood vessels.
The paratracheal muscles are pulled apart using a surgical hook.
The 4 cervical fascia (connective membranes of the muscles) are dissected and the isthmus of the thyroid gland is displaced.
The trachea is cut transversely between the second-third or third-fourth ring of the trachea (the most common option, but not the only one). In order not to damage the recurrent nerves of the larynx, the incision is made no more than 1/3 of the diameter of the trachea. The trachea of children is incised with extreme caution to avoid inserting a tracheostomy into the submucosal layer.
A Trousseau tracheal dilator is inserted into the resulting wound, after which the tracheostomy is inserted with screwing movements. The edges of the mucous membrane are sutured to the skin if the device is planned to be worn continuously.

Specialists provide patients with detailed instructions on how to care for a tracheostomy and how to remove the tube themselves if the device is installed for a long time. But it is not recommended to replace the device yourself to avoid negative consequences. Decanulation of a tracheostomy is a simple procedure. After removing the tube, the established edges are cut if they have already formed on the patient’s neck. A gentle bandage is applied to the wound. For 3 months after decanulation, the patient should be under medical supervision.

Complications of tracheostomy

Tracheostomy surgery is a complex process, even in a well-equipped hospital operating room. The doctor performing tracheostomy must have certain qualifications. A prerequisite is the presence of at least two assistants during the operation. The placement of a tracheostomy can cause complications, which are classified according to the time of development. Below is a table describing the possible consequences of the operation.

Intraoperative	Damage to large vessels of the paratracheal region. Against this background, the development of embolism with consequences including death is possible. Paralysis of the vocal cords due to a violation of the integrity of the laryngeal nerves. Damage to the thyroid gland. Reflex cessation of breathing (occurs especially often in young children). Narrowing of the respiratory lumen of the trachea, death from asphyxia (if the tracheostomy is installed incorrectly). Tracheoesophageal fistula (in case of accidental damage to the inner wall of the trachea or esophagus).
Early postoperative	Bleeding from peristomal tissues with the possibility of blood entering and the formation of blood clots in the tracheal lumen. Inflammatory processes, phlegmon, focal suppuration. Subcutaneous emphysema. Aspiration pneumonia.
Late postoperative	Inflammation of the bronchi, trachea, alveoli. Development of scar tissue, tracheal stenosis after removal of tracheostomy. Non-closure of wound edges (in rare cases).

After installing the tube into the trachea, the patient receives detailed instructions from the doctor on how to care for the device. There are tracheostomies with cuffs, which involve pumping air using a bulb. This additional element of the device prevents mucus and saliva from penetrating into the lumen of the bronchi, thereby reducing the risk of developing serious complications. The cuff must be periodically deflated to reduce the compression effect on the vessels of the tracheal mucosa.

The external tracheostomy tube is replaced or removed only in a hospital by a doctor. Daily washing of the internal part of the device can be done at home. The procedure is repeated at least twice a day. Below is its detailed description:

Prepare sterile wipes, alcohol, a special brush, glycerin, bandage, 2% baking soda solution (1 teaspoon per 120 ml of water).
Remove the bandage from your neck.
Wash your hands with soap.
Stand in front of the mirror.
Turn the tracheostomy lock to the “up” position.
Take the lugs of the inner tube with your index finger and thumb and secure them tightly in your hand.
Fix the plate of the outer tracheostomy tube in your hand.
Remove the inner tube of the device.
Dip the part into a soda solution preheated to 45 degrees.
Use a brush to clean the inside of the outer tracheostomy tube to clear it of mucus and crusts.
Rinse the internal part with running water.
Dry the tube using a sterile cloth.
Treat the part with alcohol twice.
Soak a gauze pad in glycerin and lubricate the outer part of the inner tube.
Shake the part so that no drops of glycerin remain on it.
Using a screwing motion, insert the tube into the stoma.
Fix the part by moving the tracheostomy lock to the “down” position.
Remove the preparations, soda solution and brush.
Wash your hands with soap.

Patient's lifestyle

A tracheostomy can provide breathing for a long time, but the patient should handle the device correctly after surgery. In addition to timely cleaning of the tube, you should take note of the following tips:

don't sleep on your stomach;
buy a humidifier;
avoid dusty rooms;
do not go outside on windy and hot days (if possible);
avoid swimming and bathing;
protect the tracheostomy from dirt and dust with a scarf;
do not talk while eating;
master special gymnastic exercises to restore breathing.

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