Name of the Procedure:

• Common Name(s): Tracheostomy Tube Placement, Laryngectomy Tube Placement, Tracheotomy Tube
• Technical/Medical Terms: Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (PVC), silicone or equal

Summary

A tracheostomy or laryngectomy tube placement involves inserting a tube into the trachea (windpipe) through the neck to assist with breathing. The tube is typically made of polyvinylchloride (PVC), silicone, or a similar material and includes a cuff that can be inflated to secure the tube in place and prevent air leaks.

Purpose

• Conditions Addressed:
  • Severe airway obstruction
  • Long-term ventilation needs
  • Needed for patients with obstructive tumors, severe throat injuries, or surgical conditions like laryngectomy
• Goals/Outcomes:
  • Maintain an open airway
  • Facilitate breathing in patients with compromised airway function
  • Enable removal of respiratory secretions

Indications

• Severe breathing difficulties that are unmanageable by less invasive methods
• Need for prolonged mechanical ventilation
• Large obstructive lesions or tumors in the upper airway
• Inefficacy of other airway management methods

Preparation

• Pre-Procedure Instructions:
  • Fasting for at least 6-8 hours prior
  • Adjusting or stopping certain medications as advised by the doctor
• Diagnostic Tests/Assessments:
  • Blood tests to check for any underlying conditions
  • Imaging tests like chest X-rays or CT scans to visualize the airway

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A small incision is made in the neck overlying the trachea.
3. Accessing Trachea: The surgeon carefully bypasses the muscles and soft tissues to expose the trachea.
4. Insertion: A cuffed tracheostomy or laryngectomy tube is inserted into the trachea.
5. Securing the Tube: The tube is secured in place using the cuff and often sutured or strapped to the neck.
6. Post-Insertion Care: The position is verified using imaging, and the airway is checked for any leaks.

• Tools/Equipment: Tracheostomy or laryngectomy tube, blade/scalpel, retractors, suction equipment, suture materials.
• Anesthesia/Sedation: General anesthesia is common; local anesthesia with sedation may be used in certain cases.

Duration

• The procedure typically takes around 30-60 minutes.

Setting

• Conducted in a hospital operating room or specialized surgical center.

Personnel

• Surgeons, often ENT (Ear, Nose, and Throat) specialists
• Anesthesiologists
• Surgical nurses and assistants

Risks and Complications

• Common Risks: Infection, bleeding, tube dislodgment, blockages.
• Rare Risks: Tracheal stenosis (narrowing), fistula (abnormal connection) formation.
• Management: Prompt medical intervention, antibiotics, or additional surgeries may be required to address complications.

Benefits

• Immediate restoration of airway patency
• Improved ventilation and oxygenation
• Improved ability to clear respiratory secretions
• Enhanced comfort in patients requiring long-term airway support

Recovery

• Post-Procedure Care: Regular cleaning and suctioning of the tube, monitoring for signs of infection or complications.
• Recovery Time: Initial recovery typically lasts 1-2 weeks; full adaptation to the tube can take longer.
• Restrictions: Avoid strenuous activities; follow specific instructions on tube care.
• Follow-Up: Regular check-ups with the healthcare provider, possibly tube changes, and airway assessments.

Alternatives

• Other Options: Non-invasive ventilation (e.g., CPAP, BiPAP), intubation through the mouth or nose.
• Pros and Cons: Non-invasive methods may be less intrusive but might not be effective for severe airway obstructions or long-term needs.

Patient Experience

• During Procedure: The patient will be under anesthesia; thus, they will not feel the procedure.
• After Procedure: Initial discomfort in the neck and throat area, which can be managed with pain medication.
• Pain Management: Pain control methods include prescription pain relievers and instructions for self-care to ensure comfort.