การดูแลผู้ป่วย tracheostomy นพ. เธียรไชย...

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