Health education Number: NEURO-114
Introduction of tracheostomy surgery for neurological patient
To deliver intelligent and holistic medicine and to provide the best healthcare Compassion Quality Innovation Accountability
All information above has been reviewed by Neurology specialists Edited and published by the Department of Nursing,
Taichung Veterans General Hospital
Set date:2016.07.25 Revised date: 2018.08.10
1.What is tracheotomy?
It is a surgical procedure which consists of making an incision in the trachea and inserting silicon tracheostomy tube(picture 1). The doctor will evaluate patient’s condition and choose suitable anesthesia.
picture 1 anatomy of tracheotomy
2.Purpose of tracheotomy:
(1) Create an emergent airway for acute upper respiratory tract obstruction.
(2) For patient who needs to be long-term intubated(Ventilator dependence or inability to expectorate). Tracheotomy can save strength for expectoration and decrease infectious opportunity to promote comfort.
3. Indications:
(1) Endotracheal tube intubated over than two weeks.
(2) Patient who is unable to expectorate.
(3) Upper respiratory tract obstruction.
(4) Patient who needs high concentration oxygen.
(5) Ventilator dependence.
(6)Major surgery on the face or neck area.
4. Reasons that shift from” endotracheal tube” to “tracheostomy tube”:
Despite respiration and expectoration ability is impaired temporarily, patient can still have good care quality if remain effective airway
clearance.
Endotracheal tube is a short-term medical intervention for acute respiratory failure, which can be convenient for suction and ventilation.
However, the nasal or oral mucosa will be compromised by the pressure of long endotracheal tube over a long period of time(more than 14 days) and increase infectious opportunity.
On the other side, tracheotomy is a small surgery that inserts a tracheostomy tube into the trachea. Short and little tracheostomy(picture 2、picture 3) tube can also provide convenience for suction and ventilation, and furthermore promote comfort for the patient. It is a relatively
convenient and safe choice for long-term care.( picture 4)
picture 2 picture 3 picture 4
5. Preoperational preparation for tracheotomy:
(1) Attending physician will explain procedure of operation tot patient and family.
(2) Patient and family can watch tracheotomy video together.
(3) Visit successful case of tracheotomy patient.
(4) Fill consent of operation and anesthesia.
6. Complications of tracheotomy:
Postoperative hemorrhage, pneumothorax, subcutaneous emphysema, tracheoesophageal fistula, vocal cord palsy, wound infection and
proliferation of granulation tissue. However, these complications are uncommon.
7. Timing of removing tracheostomy tube.
(1) Patient who doesn’t need ventilator and oxygen therapy anymore.
(2) Improve ability of expectoration and can successfully remove sputum from respiratory tract.