Page 145 - Manual of Equine Field Surgery
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Tracheotomy                                141







                                                                                                                                                but  care  must  be  taken  to  make  sure  the  second


                                                                                                                                                flange of the tube  does not dissect subcutaneously.



                                                                                                                                                This complication  can be avoided by careful posi-


                                                                                                                                                tioning  and palpation  of the tube after placement.

                                                                            l
                                                                           'i                                                                   The  self-retaining  tracheotomy  tubes  have  the


                                                                                                                                                 advantage  of  not  completely  relying  on  the  tra-


                                                                                                                                                 cheotomy  tube  for  an  open  airway.  Therefore,


                                                                                                                                                 if  the  tube  becomes  clogged,  there  remains  a


                                                                                                                                                 residual,  albeit  compromised,  airway.  Collapse  or


                                                                                                                                                 "kinking"  of the tube  is also avoided with  the  use



                                                                                                                                                 of self-retaining  tracheotomy  tubes.










                                                                                                                                                 POSTOPERATIVE CARE
                                              Tracheotomy  -i....:,
                                                 incision  site






                                                                                                                                                     ~ostop~rative Care··




                                                                                                                                                     Tracheotomy  tube  Management:  Trache-


                                                                                                                                                     otomy  tubes  require  almost  continuous  mon-


                                                                                                                                                      itoring  and  management.  The  tubes  and  the


                                Figure 23-6  Incision  site for tracheotomy.                                                                          surrounding skin should  be cleaned  at least daily.

                                                                                                                                                      Scrubbing  of  the  tracheotomy  site  should  be


                                                                                                                                                      avoided.  Exudate  and  blood  clots  should  be


                                                                                                                                                      removed with  a  dry,  sterile  sponge, and the  skin


                                                                                                                                                      surrounding  the  site  should  be  cleaned.  Extra


                                                                                                                                                      tubes should  be immediately  available.

                                                                                                                                                      Medications:  Broad-spectrum  antibiotics  and


                                                                                                                                                       nonsteroidal antiinflammatory agents are generally


                                                                                                                                                       not  necessary  unless indicated  for  the treatment


                                                                                                                                                       of the  underlying problem.


                                                                                                                                                       Other: After removal of the tracheotomy tube, the


                                                                                                                                                       wound  is allowed  to heal by second intention  with


                                                                                                                                                       daily  cleaning.  Cleaning  of  the  wound  during

                                                                                                                                                       closure  is  performed  at  least  once  daily  or  as


                                                                                                                                                       needed  with  moistened  gauze  sponges.  Petrola-


                                                                                                                                                       tum  (Vaseline) is  applied to the  skin surrounding


                                                                                                                                                       the  surgery site to  prevent scalding from  the  anti-

                                                                                                                                                        cipated  drainage.  Healing  is generaJ\y complete  in



                                                                                                                                                        2 to  3 weeks.





   I








                                                                                      ~t;.,;f;,a.,,,__,
                                                                                                                                                     COMPLICATIONS


                          Figure 23-7  View of the tracheotomy  site just prior


                          to inserting self-retaining  tracheotomy tube.                                                                             Fortunately,  in horses  there are few complications



                                                                                                                                                     associated  with tracheotomy.  Most  complications
                          mucosa.  A stab  incision  that  is too  shallow  may



                          result  in separation  of the  mucosa  from  the  tra-                                                                      are  associated  with  the  primary  problem  rather


                          cheal  ring,  which  will increase  bleeding  and  may                                                                     than  the tracheotomy  procedure.  However, sub-


                          lead  to  granuloma  formation.  The  annular  liga-                                                                        cutaneous  smphysema,  hemorrhage,  and  inflam-


                          ment  is incised  from  rnidline  1  to  2  cm  in both                                                                     mation  are relatively common.!"  Minimizing soft


                           directions  (about  011e  third of the  circumference                                                                      tissue  dissection,  avoiding  separation  of  the

                                                                                                                                                      tracheal  mucosa  from  the  cartilage  rings,  and
                           of the lumen).


                                 A tracheotomy  tube  is then  placed  (Figure  23-                                                                   avoiding  tracheal  ring  trauma  will  minimize


                           7).  We  prefer  self-retaining  tracheotomy  tubes,                                                                       these  complications.  Rare  complications  include
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