Name of the Procedure:

Tracheostomy/Laryngectomy Tube Insertion

• Common names: Tracheostomy Tube Placement, Laryngectomy Tube Placement
• Technical terms: Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (PVC), silicone or equal

Summary

A tracheostomy or laryngectomy tube is a medical device inserted into a patient's windpipe either through a surgical incision (tracheostomy) or as a part of the surgical removal of the larynx (laryngectomy). The non-cuffed tube is made from materials like polyvinylchloride (PVC) or silicone. It helps patients breathe when the usual airway is obstructed or compromised.

Purpose

• Medical Conditions: Chronic obstructive pulmonary disease (COPD), airway obstruction, tumors, severe neck or facial injuries, and long-term unconsciousness.
• Goals: To provide an airway and ensure the patient can breathe properly if the upper airway is blocked or damaged. It can also help in clearing secretions from the airway.

Indications

• Severe breathing difficulties that cannot be managed by less invasive means.
• Obstructive conditions such as tumors, inflammation, or congenital abnormalities.
• Trauma to the neck or face requiring alternate airway access.
• Long-term ventilator support for patients unable to breathe independently.

Preparation

• Instructions: Avoid food and drink for at least 6-8 hours before the procedure. Adjust or temporarily cease certain medications as per physician advice.
• Diagnostic Tests: Blood tests, imaging studies like X-rays or CT scans, and pulmonary function tests to assess the necessity and plan the procedure.

Procedure Description

1. Initial Assessment: The medical team reviews medical history and current health status.
2. Sedation/Anesthesia: Local or general anesthesia is administered to ensure the patient is comfortable and pain-free.
3. Incision and Insertion: A small incision is made in the neck and into the trachea, and the non-cuffed tracheostomy/laryngectomy tube is inserted through this opening.
4. Securing the Tube: The tube is secured in place with sutures or a neck strap to prevent movement.
5. Post-Insertion Care: The area around the incision is cleaned, and a sterile dressing is applied.

Duration

The entire procedure typically takes about 30-60 minutes.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeons: Perform the insertion.
• Anesthesiologists: Administer anesthesia and monitor the patient’s sedation and vital signs.
• Nurses: Assist during the procedure and provide pre- and post-operative care.

Risks and Complications

• Common Risks: Infection, bleeding, tube displacement or blockage.
• Rare Risks: Damage to surrounding structures like the esophagus or major blood vessels, long-term difficulty with speech or swallowing.

Benefits

• Expected Benefits: Immediate improvement in breathing, enhanced airway clearance, and potential to reduce the frequency of respiratory infections.
• Timeline: Benefits are typically realized immediately after the procedure.

Recovery

• Post-Procedure Care: Regular cleaning of the tube and the surrounding area, monitoring for signs of infection or blockage.
• Recovery Time: Patients may need a few days to several weeks to fully recover, depending on the underlying condition. They must adhere to follow-up appointments and any restrictions on activities.

Alternatives

• Non-Surgical: Oxygen therapy, CPAP (Continuous Positive Airway Pressure) devices.
• Surgical: Endotracheal intubation.
• Pros and Cons: Alternatives like CPAP are less invasive but may not be effective for severe obstructions. Surgical intubation requires ongoing management and may be less suitable for long-term airway management compared to a tracheostomy/laryngectomy tube.

Patient Experience

• During the Procedure: Patients are usually under anesthesia, so they typically do not feel pain during the procedure.
• After the Procedure: Some soreness and discomfort around the incision site; pain can be managed with medication. Regular care and cleaning of the tube are required to ensure proper function and hygiene, but patients can generally return to normal activities after the initial recovery period, following medical advice.