Page 35 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSA V A Manual of Canine and F eline Head, Neck and Thoracic Surger y
BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

➜ OPERATIVE TECHNIQUE 2.1 CONTINUED
VetBooks.ir The tube is secured and skin

sutures placed.

POSTOPERATIVE CARE
Tracheostomy tube care
The tracheostomy tube bypasses the normal warming and humidification mechanisms and creates airway inflammation
that is superimposed on the inflammation associated with its placement. Dedicated care is essential to prevent
potentially fatal occlusion of the tube by exudates and airway mucus.
Inner cannula cleaning

The inner cannula should be removed for cleaning whenever an increased noise or effort associated with breathing is
noticed, or every 2 hours initially. The cannula should be cleaned thoroughly using warm water, dried and replaced.
Humidification
If the inner cannula is found repeatedly to be full of tenacious mucus and exudate, either periods of nebulized air should
be provided for the animal to breathe or 0.1 ml/kg sterile saline should be instilled into the tube every 2 hours (the latter
may induce transient coughing).
Suction

This is not a benign procedure and should be done sparingly. Repeated suctioning of the airway can cause
‘desaturation’ of the patient’s haemoglobin with oxygen and exacerbate airway inflammation. It is more commonly
needed in smaller dogs and cats. The patient should be preoxygenated for approximately 10 breaths prior to
suctioning. The catheter should be introduced aseptically into the tube and suction applied for no more than 15
seconds whilst gently rotating the suction tube. Suction should be performed at least four times a day. Some
coughing, retching or gagging may be seen during suctioning. Ideally a sterile catheter should be used each time, but if
this is not possible the catheter should be flushed with sterile saline and changed daily.

Wound management
The tracheostomy wound should be inspected daily and cleaned with sterile saline and swabs as necessary.
Tube changes

If the above measures do not relieve breathing difficulty, the whole tube should be changed; this should not be done in
the absence of a clinician or of facilities for endotracheal intubation and administration of oxygen. The patient is
preoxygenated and the trachea stabilized using the stay sutures, applying gentle traction away from the wound. The
old tube is removed and a new one inserted rapidly.

26 26

Ch02 HNT.indd 26 31/08/2018 10:28