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 = larynxt = thyroidms = manubrium sterni1 = sternohyoid muscle2 = thyrohyoid muscle3 = sternothyroid muscle4 = omohyoid muscle5 = cricothyroid muscle6 = superior thyroid artery7 = medial branch of superior thyroid artery8 = thyroid capsule vessel9 = left sternocleidomastoid muscle10 = pretracheal region11 = 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

(Lalouette’s 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 KontroversialBeberapa 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

Expectorationo 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.

Suctioningo 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 tubeo Variasi tergantung keperluan yang akan digunakan

Tube changeso Frekuensi pergantian tergantung dari tipe sekreto Tube bagian dalam dapt diganti tiap 30 menit tetapi

setiap pasien harus dinilai secara berkelanjutano Dengarkan suara Nafaso Jika sekret minimal cukup ganti tube sekali seminggu

Tracheostomy Dressingo Lingkaran disekitarnya harus selalu dijaga

kebersihannya dan dijaga jangan sampai basah.Self Care

o Mengganti tube dalam dari Trakeostomyo Lembabkan dengan spray nebulizero 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

Intraoperatifo Pneumothorax/pneumomediastinumo Trauma pada n.Laringeuso Perforasi Dinding posterior trakeafistula

Mesdiatinitis o Perdarahan dari V.Jugularis anterior,istmus tiroid,

Thiroido Airway Fire

Post Operatifo Perdarahan 48 Jam pertamao Perdarahan Minimalo Infeksio Obstruksi Lumen Tubeo Dislodged Tube

Letak Tracheostomy Yang Benar

TERIMAKASIH