Tracheotomy

Question 1

How many Arteries and Veins supply the Thyroid?

Answer 1

• 2 Arteries (Superior, Inferior)

- 3 Veins (Superior, Middle, Inferior)

Question 2

What Nerve must be protected when operating around the Thyroid?

Answer 2

Recurrent Laryngeal Nerve (Left and Right)

Question 3

What is the result of a Recurrent Laryngeal Nerve injury?

Answer 3

• Hoarse Voice

- Noisy Breathing

Question 4

What is a Tracheostomy?

Answer 4

Surgical procedure to create pathway from Trachea to Skin

Question 5

What does a Tracheostomy allow for?

Answer 5

• Airway support due to obstruction

- Assisted ventilation

Question 6

Why would a patient get a Tracheostomy?

Answer 6

• Being intubated for an extended period of time (ET tubes used less than 7 days)
• Cancer patients

Question 7

What is Patient Positioning for a Tracheostomy?

Answer 7

• Supine with bilateral arms tucked
• Neck extended
  
  • Shoulder roll under scapula
  • Head placed in Ring Pillow
  • Head of bed tilted down

Question 8

What are the three specific tools for a Tracheostomy?

Answer 8

• Tracheal Hook
• Tracheal Spreader
• Tube Extension

Question 9

What are the typical sizes of Trach Tube used?

Answer 9

• 6 (Female)

- 8 (Male)

Question 10

What is the purpose of the Tube Extension for a Tracheostomy?

Answer 10

Allows Anesthesia access to connect a ventilator

Question 11

True or False: You don’t need to check the Tracheostomy Tube prior to making an incision.

Answer 11

False

-Check for size and cuff (if needed)

Question 12

What are the parts of a Tracheostomy Tube?

Answer 12

• Tracheostomy tube
• Cuff
• Balloon
• Inner cannula
• Obturator

Question 13

Why must the Scrub Tech check the Tracheostomy Balloon prior to making an incision?

Answer 13

• Check for manufacturer defects

- Make sure balloon inflates)

Question 14

Where is the skin incision made for a Tracheostomy?

Answer 14

Transverse incision midway between Cricoid and Sternal Notch

Question 15

Why is a vertical skin incision made during emergency Tracheostomies?

Answer 15

To avoid vessels (no time to be careful)

Question 16

What is done after making the skin incision during a Tracheostomy?

Answer 16

• Dissect the Platysma
• Separate the Sternohyoid muscles
• Divide Thyroid Isthmus
• Expose Trachea

Question 17

How is the Thyroid Isthmus divided?

Answer 17

Silk suture lower poles and cut up the middle (doesn’t affect Thyroid function)

Question 18

Where are stay sutures placed and why are they needed?

Answer 18

Prolene used between 3rd and 4th Tracheal Rings to identify opening again if Trach Tube falls out

Question 19

Where is the Tracheal Incision made?

Answer 19

Centrally along the Third Tracheal Ring

Question 20

What instrument do you use for a Tracheal Incision?

Answer 20

15 blade (Bovie is a fire hazard)

Question 21

What is done after making the Tracheal Incision during a Tracheostomy?

Answer 21

• Tracheal Spreader inserted
• Tracheostomy tube inserted
• Obturator removed
• Inner Cannula inserted
• Balloon inflated
• Ventilator attached

Question 22

How is the Tracheostomy Tube secured?

Answer 22

Flanges are sutured to skin using Nylon suture (Simple Interrupted)

Question 23

What are the dressings for a Tracheostomy?

Answer 23

• Trach tube tape around neck to help secure tube

- Trach gauze around tube to staunch bleeding