tracheostomy

[saicanran]

Dear colleagues, I am new to this forum but would appreciate if anyone of you out there could help me with this question..

a) Briefly Explain the physiotherapy management in tracheostomy
b) Explain the suctioning technique and its complications with references.

I hope to hear from you all soon.
Thanks

saicanran

[Kiefer]

In most situations, the surgery is performed in the intensive care unit or in the operating room. In either location, the patient is continuously monitored by pulse oximeter (oxygen saturation) and cardiac rhythm (EKG). The anesthesiologists usually use a mixture of an intravenous medication and a local anesthetic in order to make the procedure comfortable for the patient.
The surgeon makes an incision low in the neck. The trachea is identified in the middle and an opening is created to allow for the new breathing passage (tracheostomy tube) to be inserted below the voice box (larynx). Newer techniques utilizing special instruments have made it possible to perform this procedure via a percutaneous approach (a less invasive approach using a piercing method rather than an open surgical incision).





It is important to understand that a tracheostomy, as with all surgeries, involves potential complications and possible injury from both known and unforeseen causes. Because individuals vary in their tissue circulation and healing processes, as well as anesthetic reactions, ultimately there can be no guarantee made as to the results or potential complications. Tracheostomies are usually performed during emergency situations or on very ill patients. This patient population is, therefore, at higher risk for a complication during and after the procedure
The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is listed here for information only in order to provide a greater awareness and knowledge concerning the tracheostomy procedure.



1.Airway obstruction and aspiration of secretions (rare).

2. Bleeding. In very rare situations, the need for blood products or a blood transfusion.
3.Damage to the larynx (voice box) or airway with resultant permanent change in voice (rare).
4.Need for further and more aggressive surgery
5.Infection
6.Air trapping in the surrounding tissues or chest. In rare situations, a chest tube may be required
7.Scarring of the airway or erosion of the tube into the surrounding structures (rare). 8.Need for a permanent tracheostomy. This is most likely the result of the disease process which made the a tracheostomy necessary, and not from the actual procedure itself.
9.Impaired swallowing and vocal function
10.Scarring of the neck