emergency tracheotomy

DEFINITION:

 Assisting in creating a surgical opening into the anterior wall of trachea and inserting trachesotomy tube to maintain patent airway.

PURPOSES:

To bypass upper airway obstruction and trauma

To remove tracheobronchial secretions

To facilitate long term use of mechanical ventilation

To prevent aspiration of oral or gastric secretion in an unconscious or paralyzed patient

To replace endotracheal tube when long term mechanical ventilation is required

EQUIPMENT:

1.      Tracheostomy set containing the following:

a.       Toothed dissecting forceps – 1

b.      Curved mosquito forceps – 2

c.       Straight mosquito forceps – 2

d.      Artery forceps – 2

e.       Allis forceps – 2

f.       Needle holder

g.       Double hook retractors – 2

h.      Blunt hook

i.        Cricoid hook

j.        Sharp surgical scissors

k.      Tracheal dilator

l.        Dressing cups – 2

m.    Suction catheter with connection

n.      Cutting edge suture needle with thread 40 cotton

o.      Dressing forceps

p.      Surgical towels – 2

q.      K – basin

r.        Scalpel blade

s.       Cotton balls

t.        Gauze pieces

2.      Injection tray with

a.       Xylocaine 2%

b.      Syringe 5cc

c.       Needles – 20G, 22G

3.      Other equipment

a.       Gloves & Mask

b.      Saline

c.       Antiseptic solution for cleaning site of incision

d.      Dressing mackintosh

e.       Dressing towel sand bag

f.       Spot light

g.       Tracheostomy tube of appropriate size

h.      Vaseline gauze

i.        Plastic syringe 5cc to inflate air into the tracheostomy tube bulb

j.        Tape to secure tracheostomy tube in place

k.      Scissors

1	Explain the procedure to patient if conscious and get consent from the patient/relatives
2	Assemble equipment and bring to patient’s bedside
3	Place the patient in supine position with full extension of neck and head by placing the sand bag under the shoulders
4	Remove gown and expose neck
5	Keep suction and oxygen ready for use
6	Ensure adequate lighting
7	Assist in preparing skin and administering local anesthesia
8	Assist and support patient as incision is made and provide suitable tracheostomy tube for insertion
9	Assist in securing tracheostomy tube to neck by tying with tape
10	Assist while the tube is being sutured in place. Assist in initial suctioning. Provide Oxygen if prescribed
11	Place Vaseline gauze around the tube to provide lubrication
12	Assist the patient to a comfortable position
13	Replace equipment
14	Document the time, tube size, purpose of tracheostomy and the patient’s condition
	Post procedure care
1	Connect to ventilator
2	Place patient in semi fowler’s position
3	Check vital signs every 15min for first hour, every half an hour for 3 hours
4	Administer analgesics and sedatives as per order
5	Watch for complications like bleeding, respiratory failure, blockage of tracheostomy tube with secretions eg., pneumothorax, subcutaneous emphysema etc., for 24 hours
6	If metal tube is inserted, secure stilet at the head end of bed
7	Keep suction apparatus and suction tube ready at bedside