Page 215 - KNJIGA SAŽETAKA

INOVACIJE I IZAZOVI U OBRAZOVANJU I SESTRINSKOJ SKRBI - KNJIGA SAŽETAKA

Health Care of Patients in Percutaneous Dilation

Tracheotomy

The main indication for tracheotomy in intensive care units is prolonged mechanical ventilation,
difficulty weaning from artificial respiratory support and the need for clean and safe airways in
non-contact and insufficiently rehabilitated patients.

Tracheotomy enables better hygiene of the airways, reduces the work of breathing and thus
facilitates weaning of the patient from mechanical ventilation support, and thus shortens the
stay in the Intensive Care Unit.

Percutaneous tracheotomy is a procedure to open an opening in the front wall of the neck to
allow breathing. It is used in patients who have an obstruction to breathing in the upper
respiratory system.

We distinguish several methods of percutaneous dilatation tracheotomy. The Ciagla method, in
which the puncture is made between the first and second or second and third tracheal rings, then
a guide wire is introduced through the needle, and a catheter is inserted over it, taking care not
to bend the wire. This is followed by the introduction of larger and larger dilators up to the size
of 36 French (12 mm). The Griggs method in which, after tracheal puncture and placement of
the guide wire, a special dilatation instrument, the so-called, is inserted into the puncture site.
Howard-Kelly forceps, with which the opening in the trachea is widened. This is followed by
the insertion of the cannula over the guide wire The Fantony method, the main advantage of
which is very little trauma to the trachea, since the cannula is pulled out. The downside is the
technical complexity. With known difficult intubation, this method is not indicated.

Indications for percutaneous tracheotomy are prolonged mechanical ventilation and the need
for a clear, patent airway in patients who are unresponsive or comatose.
The advantages of percutaneous tracheotomy are a shorter duration of the procedure, a smaller
scar than with classic tracheotomy, a lower incidence of infection, and lower financial costs.

Key words: tracheotomy, mechanical ventilation, infection

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