การดูแลผู้ป่วย tracheostomy นพ. เธียรไชย...
TRANSCRIPT
การดู�แลผู้�ป่�วย Tracheosto
myนพ. เธี�ยรไชย ภั�ทรสกุ�ลช�ย
ภัาควิ�ชา โสต ศอ นาส�กุวิ�ทยา คณะแพทยศาสตร� มหาวิ�ทยาล�ยเช�ยงใหม!
Pre-operative assurance Intra-operative period Post-operative tracheostomy care Long-term tracheostomy care
Tracheostomy patient’s care
Indications Advantages over
endotracheal tube Post-tracheostomy status
speaking eating
Complications
Pre-operative assurance
Immediate complications Patient’s position Skin incision - Tracheal incision Tracheal suture Tracheostomy tube
Type Size Length
Skin closure
Intra-operative period
Early complications Secretion →( Nebulizer )
Color, Quantity, Viscosity Dyspnea Infection Dysphagia Communication
Post-operative tracheostomy care
Late complications
Communication Home care Try off tube
Long-term tracheostomy care
Indications for tracheostomy
Upper airway obstruction
Severe aspiration P rolonged intubation
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Reduces patient discomfort Reduces need for sedation A bility to maintain oral and bronchia
l hygiene Reduces risk of laryngotracheal trau
ma Reduces dead space and work of bre
athing
Advantages of tracheostomy
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Apnea due to loss of hypoxic respirat ory drive
Bleeding Pneumothorax or pneumomediastinu
m Injury to adjacent structures Postobstructive pulmonary edema
Immediate complications
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Tracheal incision
Tracheal incision
Tracheal incision
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Types of tracheostomy tube
Material Metal (Silver-Stainless steel) Plastic (Polyvinyl chloride) Silicone
Cuffed or Uncuffed Single or double tubes Fenestrated tubes
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Early bleeding Subcutaneous emphysema Plugging with mucus Displacement Atelectasis Tracheitis Cellulitis
Early complications
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Bleeding Tracheomalacia Stenosis Tracheoesophageal fist
ula Tracheocutaneous fistul
a
Late complications
Granulation
Scarring Failure to
decannulate
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Care for your stoma Clean the inner cannula Tracheostomy tube holder Know basic safety and what to
do in an emergency
Home tracheostomy care
Basic safety
Bathing: Trouble breathing: Secretion: Tube dislodgement: Protection of foreign body:
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1 . Immediate complication s
2. Early complications3. Late complications
Complications of tracheostomy