TRACHEOSTOMY

Anatomy
Fig. 1.2 Superficial landmarks: lateral view
1 = zygomatic process of the temporal bone
2 = auriculotemporal nerve and superficial temporal
pedicle
3 = caput mandibulae
4 = parotid duct
5 = external auditory canal
6 = angle of mandible
7 = facial pedicle
8 = transverse process of atlas
9 = inferior parotid pole
10 = apex of mastoid
11 = sternocleidomastoid muscle
12 = submandibular gland
13 = apex of greater cornu of hyoid bone
14 = carotid bifurcation
15 = laryngeal prominence
16 = cricoid cartilage
17 = emergence of spinal accessory nerve (peripheral
branch)
18 = trapezius and entrance of spinal accessory nerve
(peripheral branch)
19 = inferior belly of omohyoid muscle
20 = external jugular vein
21 = clavicle
22 = sternocleidomastoid muscle (clavicular head)
23 = sternocleidomastoid muscle (sternal head)
1 = mental eminence
2 = inferior border of mandible
3 = facial pedicle
4 = submandibular gland
5 = hyoid bone
6 = angle of mandible
7 = sternocleidomastoid muscle
8 = external jugular vein
Fig. 1.3 Superficial
landmarks: anterior view
9 = laryngeal prominence
10 = cricoid
11 = isthmus of thyroid gland
12 = sternocleidomastoid muscle (sternal
head)
13 = sternocleidomastoid muscle (clavicular
head)
14 = inferior belly of omohyoid muscle
15 = anterior border of trapezius muscle
16 = clavicle

l = larynx
t = thyroid
ms = manubrium sterni
1 = sternohyoid muscle
2 = thyrohyoid muscle
3 = sternothyroid muscle
4 = omohyoid muscle
5 = cricothyroid muscle
6 = superior thyroid artery
7 = medial branch of superior thyroid
artery
8 = thyroid capsule vessel
9 = left sternocleidomastoid muscle
10 = pretracheal region
11 = common carotid artery
l= larynx
t = thyroid gland
tr = trachea
c = clavicle
1 = superior thyroid artery
2 = inferior thyroid artery
3 = right thyroid lobe
4 = isthmus of the thyroid gland
5 = left thyroid lobe
6 = pyramidal thyroid lobe
(Lalouettes lobe)
7 = ima thyroid artery
8 = inferior thyroid artery
9 = pretracheal lymph nodes

Definisi
Tindakan Prosedur pembedahan untuk membuka
trakea melalui incisi di leher.
INDIKASI
ABSOLUT
Impending Airway Obstruction from bulky tumour
Partial Laryngectomy
Total Glosectomy
Disrupted Mandible
Bilateral Radial Neck Disection

RELATIF
Total or Partial Pharyngectomy
Partial Glosectomy
Any Operation onthe palate or oral cavity
Patient likely to need prolonged postoperative respiratory
support
Dificult intubation,patient likely to need futher anasthesia in
near futrure

Timing
Masih Kontroversial
Beberapa setuju pemasangan dilakukan bila sudah
dipakai alat intubasi selama 14 hari,lamanya dirawat
dan ada tidaknya infeksi nosokomial
Utk yang elektif,paling utama adalah optimalisasi
keadaan pasien.Idealnya INR minimal 1.5,trombosit
lebih dari 50.000,
Pasien dengan kebutuhan PEEsP(Positive End
Expiratory Pressures)> 15 CmH2O emfisema
subkutan,pneumothorax
PERALATAN
Spesific Management Issues
Expectoration
o SaluranUdara harus dijaga bebas dari sekret dan ini akan lebih
efekif dengan menganjurkan pasien untuk batuk,tidak hanya
saluran menjadi bersihntapi juga mengembangkan
paru,mencegah atelektasis dan pneumonia.

Suctioning
o Jika Pasien terlalu lemah untuk batuk sekret harus di hisap
dari trakea,jangan masukan kateter terlalu dalam melebihi
dari canul,dilakukan dengan menarik mundur dan gerakan
memutar,tindakann tidak boleh lebih dari 10 menit
Type of the tube
o Variasi tergantung keperluan yang akan digunakan

Tube changes
o Frekuensi pergantian tergantung dari tipe sekret
o Tube bagian dalam dapt diganti tiap 30 menit tetapi setiap
pasien harus dinilai secara berkelanjutan
o Dengarkan suara Nafas
o Jika sekret minimal cukup ganti tube sekali seminggu
Tracheostomy Dressing
o Lingkaran disekitarnya harus selalu dijaga kebersihannya dan
dijaga jangan sampai basah.
Self Care
o Mengganti tube dalam dari Trakeostomy
o Lembabkan dengan spray nebulizer
o Encerkan sekret yang kental

TAHAPAN TINDAKAN
The first incision is made either horizontally or
vertically, midway between the cricoid cartilage and
the sternal notch;
The sternohyoid and sternothyroid muscles are then
separated in the midline (at the linea alba) with a
vertical incision
A cricoid hook is used to elevate the larynx so that the
tracheal rings are well visualized
The tracheostomy tube flange is then secured to the skin
of the anterior neck at four points using 2-0 silk sutures,
and a twill tracheostomy tie is placed.

Komplikasi
Intraoperatif
o Pneumothorax/pneumomediastinum
o Trauma pada n.Laringeus
o Perforasi Dinding posterior trakeafistula Mesdiatinitis
o Perdarahan dari V.Jugularis anterior,istmus tiroid, Thiroid
o Airway Fire


Post Operatif
o Perdarahan 48 Jam pertama
o Perdarahan Minimal
o Infeksi
o Obstruksi Lumen Tube
o Dislodged Tube
Letak Tracheostomy Yang Benar
TERIMAKASIH