Tracheostomy complications

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Background

Tracheostomy Sizes

(1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea (A) Cricothyrotomy site (B) Tracheotomy site
Tracheotomy in situ
1 – Vocal folds
2 – Thyroid cartilage
3 – Cricoid cartilage
4 – Tracheal rings
5 – Balloon cuff
Shiley™ trach tube
  • Average size:
    • Adult: 5-10mm
    • Peds: 2.5-6.5mm

Tracheostomy vs laryngectomy

It is important to differentiate between tracheostomy vs laryngectomy

  • If laryngectomy[1]:
    • The stoma is the only way to ventilate the patient.
    • Patient cannot be orally intubated

Clinical Features

Differential Diagnosis

Tracheostomy complications

Evaluation

  • Attempt to find out if patient has a tracheostomy vs laryngectomy from history. If the latter is present, the stoma is the only way to ventilate the patient.[2]

Management[3]

  • Call for airway expert help
  • Sit patient up or in a position of comfort
  • Place on trach collar oxygen or place non-rebreather mask mask on trachesostmy while preparing
    • If any doubt about tracheosomy vs. laryngectomy, be sure to oxygenate nasal/oral airway in addition to stoma
  • Don faceshield, have suction, oxygen, flushes (possibly surgical airway supplies)
  • Remove speaking valve or cap (if present)
  • Remove inner cannula
  • If unable to pass suction catheter at this point, deflate cuff and consider removing tracheostomy tube

Disposition

See Also

References

  1. https://www.ccam.net.au/handbook/tracheostomy/ Date accessed: 4/24/2018
  2. https://www.ccam.net.au/handbook/tracheostomy/ Date accessed: 4/24/2018
  3. National Tracheostomy Safety Project. Review date 1/4/2014

Authors:

Ross Donaldson