Breathing tube in the throat. What is and proper care of a tracheostomy. Breathing tube. When is a tracheostomy performed?

07.12.2016

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

The chemical element plays an important role in the metabolic processes of tissues and organs. The delay in 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 tracheostomas are used for long-term, permanent wear, plastic tubes are used for occasional use.

A correctly installed artificial throat can provide full respiratory function in case of impossibility of natural use of the upper respiratory tract. During the insertion procedure, 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 for mechanical ventilation, or in an emergency to save a life.

Indications for tracheostomy are:

allergic edema (Quincke's edema);
obstruction of the airways due to injury or ingestion of a foreign object in the throat;
damage to the trachea;
TBI (brain injury);
stroke;
stenosis of the larynx;
severe forms of angina;
throat cancer.

Conducting a tracheostomy

The blockage can be predictable, chronic inflammation, throat cancer, or sudden. In the case of the passage of the acute phase of the disease, the normalization of the patient's condition, which required the installation of a tracheostomy, the tube is removed, the hole is sutured.

The procedure for the operation is of several types:

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

Severe illnesses, the impossibility of independent breathing will require long-term wearing of the product until the restoration of natural respiratory processes. Lifelong wearing of an artificial throat is used when the trachea is completely removed after throat cancer.

The operation of tracheostomy, even in a medical institution, is a complex surgical procedure and is performed in a certain sequence. After the procedure, various types of complications may occur that require urgent elimination.

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

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

Recovery of respiratory function

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

Carrying out simple exercises to train muscles will help strengthen the lungs, accelerate adaptation and recovery. It is recommended to regularly perform special gymnastic exercises, inflate balloons and blow air through a tube into a glass of water.

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

Tracheostomy care

The installed tracheostomy requires special attention and care. Initially, when you are in a medical facility, the state of the tube is monitored by specialists. After the end of the formation of the tracheotomy course, 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 sorts of complications. The hole in the trachea will eventually stop narrowing. A fully formed lumen is an indication for removal of the cannula from the tracheostomy.

The product care process includes:

timely daily cleaning and removal of the tube from the stoma;
thorough washing from mucus, crusts in a special solution;
wiping with medical alcohol using a sterile wipe;
lubrication of the outer surface of the tube with glycerin;
gentle insertion of the cannula into the stoma with a slight screwing motion.

During the patient's stay 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 for the return of the cannula to the tracheostomy.

Before the procedure, the skin around the lumen, 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 airways and properly 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 rehabilitation are:

specific sound of swallowing from the cannula;
restless behavior, patient discomfort;
visible secretions of sputum, or saliva.

The patient is advised to sleep in the supine position, avoiding the possibility of accidental occlusion 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 wet or dirty.

It is important to take good care of the neck around the stoma by systematically disinfecting with a hydrogen peroxide solution. Hygiene of the body of patients after trachostomy is performed using special means that do not require subsequent rinsing.

A temporary, or permanent, tracheostomy will require serious consideration of the restrictions and strict adherence to the rules for this type of patient. The habitual way of life will need to be changed in accordance with the recommendations of the attending physician.

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

Main hazards to avoid:

walking in windy, hot, or cold weather;
accumulation of mucus, sputum in the tube;
being in dusty, gassed places;
sleep on the stomach;
diving, showering, swimming.

Useful tips and recommendations will help make life easier for the patient after a tracheostomy:

Restoration of respiratory, swallowing, motor functions will be much easier and painless when performing special gymnastic exercises.
Specific noise, wheezing - indicate the need to clean the cannula.
Eating should take place in a relaxed atmosphere. During this, the patient should not laugh or talk.
In severe cold, the stoma should be covered with a thick gauze bandage, avoiding deep breaths.
Dry or hot weather will require occasional dampening of the gauze.
It is important to carry out daily, thorough oral care, which will prevent the development of complications, 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, a light scarf.

The first time after surgery, the patient will not be able to talk. Until the restoration of functions for communication, or description of the state, you can use a regular notepad or smartphone.

There are also tracheostomies with a special phonation window that allow sonorous speech to be made by closing the cannula outlet, raising the airflow to the vocal cords.

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

Breathing is one of the most important life-support processes, for which air must pass through the nasal cavity, larynx and trachea, however, if the upper respiratory tract is obstructed, it can be disturbed, and then breathing becomes impossible. Acute obstruction occurs for a variety of reasons, and the doctor sometimes has a few minutes at his disposal, during which you need to make the right decision and take action.

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

The tracheostomy operation can be performed both on an outpatient basis (according to vital indications) and in a hospital - urgently or planned. This is a complex procedure that carries a high risk of complications, and it is far from always successful even with an impeccable surgeon's 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 best method of anesthesia, but in the absence of the possibility of its implementation, local anesthesia is used. Inadequate analgesia can cause a poor outcome, although in emergency cases the surgeon may sacrifice the patient's sensations in order to save his life. There are cases when a tracheostomy was performed without anesthesia at all, but at the same time it was possible to establish breathing and bring the patient back to life.

A tracheostomy should be performed by a specialist who knows 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 delivered to the hospital, a tracheostomy will be performed in safer conditions.

Video: tracheostomy - medical animation

Indications and contraindications for tracheostomy

The reason for the tracheostomy is considered a violation of breathing, in which air cannot enter the trachea through the overlying sections. Respiratory distress can be lightning fast when asphyxia grows in seconds, acute when it comes to minutes. Subacute obstruction of the airway is formed over several hours, and chronic - for a long time, for a day, 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, carried out in a hospital for patients with chronic respiratory disorders.

In children, the most common causes 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, both foreign bodies and severe injuries can become a reason for opening the trachea; in the elderly, tumors that obstruct the airways, as well as chronic pulmonary pathology, suggesting prolonged artificial ventilation of the lungs, are likely.

The first help outside a medical institution for asphyxia 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 lasting effect, therefore, after transportation to the hospital, a tracheostomy is performed.

It seems to many that it is not so difficult to cut the trachea for air access, it is enough just to put the victim correctly and arm yourself with a cutting object. However, the proximity of the location of large vessels, the thyroid gland, and nerves make 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 are described, and they are not isolated, when a child died without emergency qualified assistance, and especially desperate parents performed a 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, which develops over months and even several years, is formed due to perichondritis of the larynx (cartilage inflammation), a growing malignant or benign tumor, cicatricial narrowing after burns or injuries.

There are no contraindications to tracheostomy surgery. It will not be done to a patient in an agonal state due to inappropriateness, all other patients will undergo a tracheostomy, regardless of age, comorbidity, 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 cut, this is the initial stage of the tracheostomy operation.

Opening the trachea is performed using tracheostomy tools that 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 something that comes to hand is fraught with dangerous complications and death of the patient, so it is better to entrust it to professionals in an operating room, where appropriate tools are available.

operation technique

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

Depending on the section of the trachea in which the tracheotomy occurs, it is 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 with complications, but it is chosen when the first two types are technically impossible to implement. In the direction of the incision of the tissues of the neck and trachea, tracheostomy can be transverse, longitudinal, U-shaped.

Tracheostomy or tracheotomy surgery requires general anesthesia, but in emergency cases, local anesthesia with novocaine solution is sufficient, which is injected into the soft tissues of the neck. To enhance the effect of local anesthesia, sedatives are additionally administered intravenously.

An intervention performed without anesthesia at all sharply reduces the chances of a favorable outcome of the procedure and is practically impossible. In 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 case of asphyxia, there is simply no time for it. In preparation for a tracheostomy, the following may be prescribed:

General clinical tests of urine and blood;
Radiography of the lungs;
Coagulogram.

Without fail, the surgeon evaluates the list of medications taken, especially 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 the tracheostomy operation, regardless of the level of its implementation, include:

Putting the patient in the correct position;
Dissection of the soft tissues of the neck and trachea;
Introduction of a tracheostomy cannula into the respiratory tract;
Strengthening the air duct and suturing the skin.

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

After immersing the patient in anesthesia, the surgeon treats the operating field in the usual way, limits it with sterile napkins, and starts the soft tissue incision 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 bred with blunt hooks to the sides, the isthmus of the thyroid gland is found above the cricoid cartilage of the larynx, which is retracted downward. The larynx, which can convulsively contract, 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 III (sometimes IV) tracheal cartilage, acting very carefully, because large vital vascular trunks pass nearby. When an air stream enters the trachea from outside, breathing stops for a short time (apnea), followed by an active cough push, after which a dilator is introduced into the trachea. A tracheostomy cannula of the desired 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 upward along 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 downward with a hook to prevent damage to it with a scalpel, the deep fascia are dissected, and the muscles are retracted to the sides. The fiber in front of the trachea is pushed back, the vessels are tied up, the thyroid gland is shifted upwards. Having gained access to 4-5 cartilaginous rings, the surgeon dissects them, directing the scalpel upward, from the sternum, so as not to touch the large vessels.

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

The technique for 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.

Classical tracheostomy is performed in an operating room and carries great risks. So, according to some reports, at least a third of patients face complications after surgery. To reduce the chance of complications and facilitate the surgical technique, operation of percutaneous tracheostomy (puncture-dilatation).

Percutaneous tracheostomy has several advantages:

It can be carried out outside the operating room, at the patient's bedside;
Requires less time than an open tracheostomy;
Minor surgical trauma, so the risk of bleeding and infection is lower;
Good cosmetic result.

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

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

Percutaneous tracheostomy technique:

The patient is placed on his back with his head thrown back, under the shoulder blades - a roller;
Treatment of the puncture site with antiseptics;
Horizontal incision of soft tissues, which are moved to the sides with blunt hooks, exposing the tracheal rings;
Introduction of a puncture needle between I and II or II and III cartilaginous rings, placement of a flexible conductor into the needle;
Introduction of dilators along the conductor until a hole of the required diameter is formed;
Placement of a tracheostomy tube with a dilator in the trachea, 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, then inserts a thick needle with a cannula, which remains in the lumen of the trachea. A conductor is inserted through the cannula into the trachea. Next, a small incision is made in the soft tissues with a scalpel, and the hole for the tracheostomy is expanded with 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 an 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 its exit from the still unformed stoma. In addition, it is very important that the size of the tube and the opening in the trachea match, otherwise bleeding, rupture of the trachea, and incorrect position of the tube relative to the tracheal wall are possible.

As you can see, any tracheostomy technique, whether it be an open method or a percutaneous one, is rather complicated and requires appropriate skills, availability of instruments, 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, complications are not uncommon. The probability of their occurrence depends on the time that has passed after 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 of tracheostomy include:

Bleeding when traumatizing the arteries of the neck, air embolism when opening the veins;
Infection (probability with open surgery up to 40%);
Damage to the posterior wall of the trachea, esophagus;
Ingress of blood into the bronchi and aspiration pneumonia as a result;
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 operation technique. Incorrect installation of the tube, its displacement or prolapse, blockage, mismatch between the diameters of the tube and the tracheal incision are possible - if the hole is too large, then subcutaneous emphysema will develop, and the tube will move or fall out, if the hole in the trachea is insufficient, there is a risk of cartilage necrosis.

Video: tracheostomy in a hospital

Video: performing an emergency tracheostomy

Postoperative period and prognosis

The tracheostomy tube can provide the breathing process for a long time, so in the postoperative period, the patient must know how to properly handle it. First of all, the external opening should be kept clean, dressings should be changed in a timely manner, 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 with a tube, household chemicals can be dangerous.

In the presence of a tracheostomy, there may be some speech difficulties, which usually take a few days to overcome. When speaking, the opening of the tracheostomy must 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 underlying disease, which can be chronic with irreversible consequences.

In all cases when the condition of a patient with a tracheostomy has suddenly worsened, the tube has fallen out or moved, there are signs of inflammation in the airways, fever, any changes in the site of the skin incision or worsening of breathing, you should immediately consult a doctor.

Video: tracheostomy tube care and change

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In order to educate your patient and their loved ones on the proper care of a tracheostomy tube at home, you must first explain to them all the procedures. It is also desirable that the transition from hospital to home conditions be as painless as possible. Use the patient-specific instructions below as a guide during the training process.

Understanding how the tracheostomy tube works

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

The tube inserted into the tracheostomy facilitates the process of breathing, because with the help of the tube the airways always remain 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. The tracheostomy straps are threaded through the holes in the tracheostomy plate to keep the tube in a constant position. The tracheostomy tube also has an internal cuff that, when inflated, helps keep the tube in a fixed position and prevents food, liquids, and secretions from entering the lungs.

Explain to the patient that all he needs to do to care for the tracheostomy tube is to wash his hands thoroughly. However, if care is provided by members of his family, they need to not only 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:
* a small kidney-shaped pelvis filled with water;
* a small brush (Note: A special brush for tracheostomy tubes can be purchased from 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. Watch out ensure that such a brush is used exclusively for cleaning the tracheostomy tube.)
* liquid dishwashing detergent (weak);
* gauze pad;
* scissors;
* clean tracheostomy bands (twill tape)

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

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

3. Prepare new tracheostomy bands.

4. Set the mirror in such a position that it is convenient to see the 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 pushing it evenly out and down.

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

8. Then clean the contaminated 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 strong, place the cannula in a hydrogen peroxide solution. You will see the foam that is formed as a result of the reaction of the solution with the secretions covering the cannula. As soon as the foam disappears, clean the cannula with a brush.

9. Then rinse the inner cannula with running water. Be sure that you have thoroughly rinsed off all cleaning solutions. Shake off any excess water from the cannula, but do not let it dry, as the remaining drops of water act as a kind of lubricant that makes it easier to re-insert the cannula.

10. Reinsert the clean cannula. Position it in place by turning the outside of the inner cannula clockwise. (Note: If desired, you can set aside the contaminated cannula and clean it later, but for now use a pre-prepared clean cannula.)

11. Replace soiled ribbons with new ones. Do not remove the old ribbons until you are sure that the new ribbons 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 fit 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 re-insert a tracheostomy tube

Let's say you accidentally cough up your tracheostomy tube. Nothing wrong. If the tracheostomy tube is not dirty, you can reinsert it. Otherwise, use a spare tracheostomy tube.

Follow the instructions below to re-insert the tube:
1. Remove the inner cannula from the displaced tracheostomy tube.
2. If necessary, deflate the cuff by attaching a rubber balloon to the cuff outlet valve and evacuate all air from the cuff.
3. Insert the obturator into the outer cannula.
4. Then reinsert the tracheostomy tube into the stoma by moving the cannula down at a slight angle.

6. Then insert the inner cannula into the tracheostomy tube.
7. Secure it in place by turning the outside of the inner cannula clockwise. It is likely that you will cough or vomit during this procedure, so be sure you have the tracheostomy plate securely in place.
8. Using a syringe, inflate the cuff as directed by your healthcare professional. The air-filled cuff is able to protect the tube from accidental re-displacement.
9. After you have inflated the cuff, tie off the tracheostomy straps and place a gauze pad under the tracheostomy plate.

How to suction a tracheostomy

You suck the tracheostomy to remove accumulated secretions. Use the following guidelines to help you remember the sequence of procedures.

1. Have the necessary tools ready:
- suction device;
- connecting tubes;
- pelvis;
- distilled water;
- suction catheter.

In the event of a malfunction 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 division. As a general rule, the division should be between 80 and 120 mmHg without going over the 120 mmHg scale.
3. Remove the suction catheter from the packaging or sealed container.

5. Immerse the free end of the catheter in distilled water to make it easier to slide the catheter.
6. Take a few deep breaths and gently insert the moistened catheter into the trachea (5 to 8 inches) through the tracheostomy tube or stoma until resistance is felt.

Caution: Be careful not to injure yourself. Try to keep the opening of the catheter open while inserting the catheter. The pressure resulting from suction can damage adjacent tissue to the trachea.

7. Use your thumb to periodically open and close the catheter opening while suction starts or ends. As you do this procedure, carefully remove the catheter from the trachea, rolling it between your thumb and forefinger. All this should not take more than 10 seconds. Otherwise, oxygen may leak from the lungs.

8. To flush 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. Discard the disposable catheter in a plastic trash can. If 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 tracheal intubation is the most effective method to ensure the patency of the upper respiratory tract, 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, C. Kite described and recommended for use the technique of pressing the larynx to the spine during air blowing to reduce ingestion into the stomach.

Only after almost 200 years this technique was re-proposed by Brian Selick and recommended for widespread use in order to prevent regurgitation before tracheal intubation.

What is it and why

Tracheostomy, or cannula from the Greek windpipe, is performed by making holes in the throat and placing in it a special tubes. They are metal and plastic, the former are more often used for constant wear, the latter for long-term, but not permanent, they are more often used abroad, because they are considered better, but both of them are rarely in the pharmacies of the city, for example, they ordered it to me in Moscow .

Conducting a tracheostomy

The first mention of tracheostomy was found in ancient Egyptian papyri. There is evidence that Alexander the Great made a hole in the larynx of his soldiers with a sword, choking on a bone. More or less reliable references point to its conduct by Asclepiades 100 BC.

During the Renaissance, the performance of tracheostomy in animals was described by Vesalius in 1543. In 1788, Anthony Portel (Antoine Portal) proposed tracheostomy as an extreme method when it is impossible to carry out artificial lung ventilation (ALV) through the mouth. Only since the 30s. tracheostomy has come into practice as a method of carrying out planned mechanical ventilation.

Purpose of installation

The tracheostomy operation is upper, middle and lower. For adults, the upper is more often performed, the lower for children (due to the different location of the thyroid gland), 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 pull a foreign object out of the throat;
angioedema;
larynx injury;
traumatic brain injury;
when a person is unconscious and cannot breathe on his own.

Not urgently, a tracheostomy is placed in special cases of tonsillitis, stenosis of the larynx and cancer of the throat.

What period is set

After a relatively mild stroke or brain injury, if a tracheostomy is needed, after an acute period, the hole (stoma) is sewn 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 such a period, the skin on the neck will overgrow itself, naturally only after the tube is removed from the hole.

In severe cases, when the cannula is standing for a long time, the stoma is overgrown, or it is sewn up for 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 by itself), it is sewn up when the injured person can perform these actions. After throat cancer, for example, when the entire trachea is cut out, the tube stays for life.

Of course, living with a cannula is 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 the respiratory and swallowing functions improved.

If we can still somehow restore motor functions with exercises, then only time will help for the normal functioning of the respiratory and swallowing systems, there are some exercises for training these muscles (blowing air through a tube into a glass of water, inflating balloons and breathing exercises), but they will be useful only to strengthen the lungs.

Rules of life 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 - it costs from 6000 r. to order, it is necessary to remove sputum (saliva) from the lungs, a person should carefully sleep on his side so that he does not accidentally close the cannula opening 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 - it is better more often, in a hospital, as a rule, this is done in the operating room, because it is not known how the body will behave without it.

Change the ribbon - the ribbon with which it is kept on the neck is desirable every day, the bandage between the hole and the "wings" must 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 part of human life support. For its implementation, it must pass the nasal cavity, larynx and trachea. If the airway is blocked, breathing becomes impossible. The causes for acute obstructions may vary, and doctors usually have little time to resolve the problem. In such cases, the patient is placed 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 conduct and care for the device.

What is a tracheostomy

If a person, as a result of an accident or the development of a serious pathology, cannot breathe fully, a tracheostomy cannula, or tracheostomy, is installed for him. The term was formed from the Latin words: trachea (breathing tube) and stoma (hole). 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 the peristomic outer tissues from the negative effects of the environment.

The cannula is inserted into the tracheal incision 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. With a short wearing period, a cannula is inserted, the edges of the wound are not sutured. Experts recommend devices for the production of which thermoplastic material is used. They become elastic at a temperature of 35-38 degrees, which protects the mucous membrane and tissues around the wound from damage.

Indications for tracheostomy

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

Often, a tracheostomy is installed in patients with a stroke and other pathologies that violate the natural respiratory processes. In addition, indications for the operation are the following:

the ingress of foreign bodies into the larynx (against which a spasm of the ligaments develops or mechanical obstacles are created for the passage of air flows into the body);
injuries, injuries in the neck that caused damage to the respiratory tract;
infections or viral diseases (tonsillitis, 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);
throat 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 stenosis of the larynx of various etiologies;
compression of the tracheal rings by aneurysm, struma, inflammatory infiltrates of the neck.

Tracheostomy in children

Respiratory failure can develop in patients of any age. Children require a tracheostomy when 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 the narrowness of the airways. Any inflammation of the larynx and subglottic space in young children is important to control by specialists.

Classification of tracheostomy

The operation to install a tracheostomy is carried out in several stages. The first step is the dissection of tissues (skin, subcutaneous tissue) and the tracheal wall, which 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 cutting tissue over the isthmus of the thyroid gland. This type of operation is the easiest to perform and is used more often than others.
The middle tracheostomy is an incision in the isthmus of the thyroid gland. This option is dangerous, because the organ can be damaged during the operation. Specialists choose a middle tracheostomy only in extreme cases when other types are not suitable (for example, for cancerous tumors).
The 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 shape of the dissection of the tracheal wall. The choice depends on the specific case and is determined after tissue dissection. There are the following options:

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

Stages of the operation

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

Surgery includes several stages. Below is a detailed description of the tracheostomy operation:

The skin and subcutaneous tissue are cut with a scalpel.
Gently dissect the white line of the neck with tissue scissors "to the light". This is done to prevent damage to large blood vessels.
The paratracheal muscles are bred to the sides with a surgical hook.
4 cervical fasciae (connecting sheaths of muscles) are dissected, the isthmus of the thyroid gland is displaced.
The trachea is cut transversely between the second-third or third-fourth tracheal ring (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. Tracheae are incised with extreme care in children to avoid inserting the tracheostomy into the submucosal layer.
Trousseau's tracheo-dilator is inserted into the resulting wound, after which the tracheostomy is inserted with screwing movements. The edges of the mucosa are sutured to the skin if the device is to be worn continuously.

Specialists give patients detailed instructions on caring for a tracheostomy and methods for self-extraction of the tube if the device is installed for a long time. But it is not recommended to replace the device yourself in order to avoid negative consequences. Decanulation of a tracheostomy is a simple procedure. After removing the tube, the accustomed edges are incised, if they have had time to form on the patient's neck. A gentle dressing is applied to the wound. Within 3 months after decanulation, the patient should be under medical supervision.

Complications of a tracheostomy

The operation to install a tracheostomy is a complex process, even in a well-equipped hospital operating room. The doctor performing the tracheostomy must be qualified. A prerequisite is the presence of at least two assistants at the operation. The installation 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 up to death is possible. Paralysis of the vocal cords against the background of a violation of the integrity of the laryngeal nerves. Thyroid damage. Reflex respiratory arrest (especially common in young children). Narrowing of the respiratory lumen of the trachea, death from asphyxia (with improper installation of the tracheostomy). 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 lumen of the trachea. Inflammatory processes, phlegmon, focal suppuration. Subcutaneous emphysema. aspiration pneumonia.
Late postoperative	Inflammation of the bronchi, trachea, alveoli. The development of scar tissue, stenosis of the trachea after removal of the tracheostomy. Non-closure of the edges of the wound (in rare cases).

After inserting the tube into the trachea, the patient receives detailed instructions from the doctor on how to care for the device. There are cuffed tracheostomies that provide for pumping air with a pear. This additional element of the device does not allow mucus and saliva to penetrate 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 only replaced or removed in a hospital by a doctor. Daily rinsing of the inside 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, a solution of baking soda 2% (1 teaspoon per 120 ml of water).
Remove the bandage from your neck.
Wash your hands with soap.
Stand in front of a mirror.
Rotate the tracheostomy lock to the “up” position.
Take the ears of the inner tube with your index finger and thumb, firmly fix in your hand.
Fix the plate of the outer tube of the tracheostomy in the hand.
Remove the inner tube of the device.
Immerse the item in a soda solution, preheated to 45 degrees.
Scrub the inside of the outer tracheostomy tube with a brush to clear it of mucus and crusts.
Rinse the interior with running water.
Dry the tube with a sterile towel.
Treat the part twice with alcohol.
Moisten a gauze cloth in glycerine, lubricate the outer part of the inner tube.
Shake the part so that no drops of glycerin remain on it.
Insert the tube into the stoma with screwing movements.
Fix the part by moving the lock of the tracheostomy to the “down” position.
Remove preparations, soda solution and brush.
Wash your hands with soap.

Patient lifestyle

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

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

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