Page 2355 - Cote clinical veterinary advisor dogs and cats 4th

1166 Tracheostomy

• Diuretics: slow mobilization of modified SUGGESTED READING AUTHOR: Lori S. Waddell, DVM, DACVECC
transudates (e.g., heart failure) compared to Lombardi R, et al: Pleural space drainage. In Burkitt EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Thompson, DVM, DABVP
VetBooks.ir causes (e.g., exudates, hemorrhage) and procedures for small animal emergency and
thoracocentesis and ineffective with other
Creedon JM, et al, editors: Advanced monitoring
critical care, West Sussex, UK, 2012, Wiley-
Blackwell, pp 378-392.

Tracheostomy Client Education Bonus Material
Sheet
Online

Difficulty Level: ♦♦ • 2-0, 3-0, or 4-0 nylon suture • Tracheal malacia
• 2-0, 3-0, or 4-0 polydioxanone suture • Excessive mucus production
Overview and Goal • Umbilical tape • Temporary (tube) tracheostomy
The creation of a temporary or permanent • Small Gelpi retractors ○ Gagging, retching, coughing, and vomiting
opening into the tracheal lumen to facilitate a • Metzenbaum scissors ○ Tube obstruction
patent airway and provide a conduit for airflow • Mosquito or Kelly hemostatic forceps ○ Spontaneous extubation
when blockage or collapse of the nasal cavity, • Suture scissors ○ Aberrant tube placement
oral cavity, nasopharynx, and/or larynx has • Needle drivers ○ Tracheal irritation leading to tracheocu-
compromised respiration Tracheostomy tubes: taneous and/or tracheoesophageal fistula
• Tube size should not exceed one-half of the ○ Vascular erosion
Indications tracheal diameter. ○ Stricture, stenosis, and mucosal erosions
Temporary tube tracheostomy: • Tube length should extend six to seven from pressure necrosis
• Upper respiratory collapse tracheal rings caudal from the stoma. • Permanent tracheostomy
• Upper respiratory obstruction • Single-lumen tubes must be removed and ○ Mucocutaneous dehiscence
• Surgery of the head and neck replaced for cleaning. ○ Stenosis and/or stricture
• Laryngeal edema • Double-lumen tubes have an inner cannula ○ Acute stomal obstruction from mucus plug
• Anaphylaxis (p. 54) that is removable and more efficient for or excessive skin folds
• Ventilator patients cleaning. However, due to the large bore ○ Excessive mucus production and
Permanent tracheostomy: size, these tubes may not be feasible in small accumulation
• Severe upper respiratory compromise that patients. ○ Tracheal irritation leading to coughing,
cannot be effectively treated with medical • Cuffed tubes are used when mechanical gagging, and mucosal erosions
management ventilator support is necessary.
• Most commonly placed in patients with Procedure
neoplasia, severe trauma, or laryngeal collapse Anticipated Time Temporary tracheostomy:
• Surgical prep: 5 minutes • Make a ventral, cervical midline skin incision
Contraindications • Temporary tracheostomy: 10 minutes extending 3-5 cm in length from the most
Lower airway disease • Permanent tracheostomy: 30 minutes caudal aspect of the larynx. Continue the
incision by blunt dissection through the
Equipment, Anesthesia Preparation: Important subcutaneous tissues to expose the underlying
Anesthesia: Checkpoints paired sternohyoid muscles.
• If performing on elective basis, general • Educate clients on potential risks and • The ventral aspect of the trachea can be
anesthesia is recommended. complications and the long-term prognosis exposed by bluntly separating the sternohyoid
• Local anesthesia (+/− analgesia/sedative) if of the underlying disease process. muscles along their midline aponeurosis and
patient is too unstable for general anesthesia • Organize all instruments before the beginning retracting the muscle bellies and skin laterally.
• In patients that are unconscious due to upper of the procedure if time allows (preferably all Retraction can be aided by the placement
airway obstruction, a tracheostomy may be supplies needed to perform a tracheostomy of Gelpi retractors.
performed in the absence of local or general should be kept in a designated surgery suite • After the ventral aspect of the trachea is
anesthesia. However, after the tracheostomy to allow quick and efficient access). exposed, proper positioning of the trache-
procedure is complete, anesthesia and • Place the patient in dorsal recumbency with ostomy should be determined by locating
analgesia are instituted before the return of towels folded and placed under the cervical the annular ligament between the 3rd and
consciousness. region to elevate and stabilize the neck 4th tracheal rings.
Surgical preparation (elective): • Perform a routine sterile preparation (if time • A horizontal tracheostomy can be made into
• Nonsterile exam gloves permits) of the ventral cervical region from the annular ligament between the 3rd and
• Hair clippers the ventral ramus of the mandible to the 4th tracheal rings. The width of the incision
• Surgical scrub solution, saline, gauze sponges manubrium. should not exceed one-half of the tracheal
Instruments and supplies: circumference due to potential damage of
• Sterile gloves Potential Complications and the laryngeal nerves.
• Sterile gauze Common Errors to Avoid • A vertical tracheostomy can be made by a
• Sterile drape • Infection midline incision through the 3rd through
• Towel clamps • Hemorrhage 5th tracheal cartilages.
• #10 and #15 scalpel blades • Dehiscence • A tracheal flap tracheostomy can be
• Scalpel handle • Subcutaneous emphysema, pneumomedias- performed by making a U-shaped incision
• Brown-Adson tissue forceps tinum, pneumothorax starting at the 3rd tracheal cartilage and

www.ExpertConsult.com