COMPS: Tracheotomy & Tracheostomy (O13)

Question 1

What is the difference between tracheotomy and tracheostomy?

Answer 1

TracheoTOMY: temporary hole in the trachea at any level, almost always as an emergency procedure to open the airway.

TracheoSTOMY: A long-term opening in the trachea (stoma). This is what laryngectomy patients have (their stoma is permant. Other tracheostomies may be closed eventually.

Question 2

What are the two criteria for whether to place a short-term tracheotomy or a long-term tracheostomy?

Answer 2

1. PUMP FAILURE (failure of diaphragm or intercostal muscle failure)
   a) “Flail chest”- ribcage gets smaller upon muscle contraction of inhaling so air goes out instead of in.
   b) Injury to brain, brainstem or spinal cord- paralysis or paresis.
2. BLOCKAGE that won’t resolve quickly enough to maintain an airway.
   * e.g., crushed larynx or stenosis of larynx (broken/swollen larynx)

Question 3

If a patient is placed on a ventilator longer than ___ to ___ days, a tracheostomy should be considered.

Answer 3

5-7 days

Question 4

What are the four indications for tracheostomy?

Answer 4

1. Length of time on ventilator (more than 5-7 days)
2. Difficulty mobilizing/clearing secretions –> pneumonia
3. Airway trauma that won’t resolve quickly.
4. Surgical indications (skull/dural surgeries, head & neck cancers, TBI)

Question 5

How do tracheostomy patients manage secretions?

Answer 5

By SUCTIONING secretions from airway to keep it patent

Question 6

How may a person who has a tracheostomy achieve voicing?

Answer 6

With a one-way speaking valve: will inhale and upon exhale, the air will go out through the trachea, larynx, mouth, and nose instead of the tube or stoma.