Tracheostomy

Contraindications for surgery

There are several contraindications to tracheostomy. Here are the main ones:

• Anatomical features (curvature of the cervical vertebrae, abnormalities of neck development) that can complicate access to the bronchi or increase the risk of damage to surrounding tissues and blood vessels
• The presence of active infectious processes in the area of ​​the proposed surgical intervention (boils, abscesses and herpetic eruptions)
• Coagulopathies. Bleeding disorders can lead to unnecessary bleeding during and after surgery
• Severe general diseases. Decompensated forms of cardiac, renal and liver failure significantly increase the risk of surgical and postoperative complications

A significant contraindication is acute inflammation of the respiratory tract. For example, acute respiratory infections often worsen after surgery.

Preparation for tracheostomy

The first stage is examination. It involves passing general and biochemical blood tests, a coagulogram, a chest x-ray and, if necessary, a CT or MRI of the neck area. Further steps:

1. Consultation with an anesthesiologist. The specialist assesses the risks associated with anesthesia and selects the appropriate type of anesthesia
2. Preparation of the surgical field. On the eve of the operation, depilation is carried out in the place where the incision will be made. Then, in order to prevent the spread of infection, this area is thoroughly washed with antiseptic agents
3. Preparation of tools. Immediately before the operation, surgical instruments are sterilized and placed in the required order. These include a scalpel for cutting, forceps to stop bleeding, special tissue scissors and instruments for drainage placement

8 hours before surgery, the patient should not eat or drink. On the day of surgery, the patient is usually prescribed medications to help them relax and reduce anxiety.

Possible complications

Like any surgical procedure, tracheostomy carries risks. Possible complications include:

• Bleeding. Occurs during tracheostomy or immediately after it. The main reason is damage to the blood vessels in the incision area
• Infection. An inflammatory process sometimes occurs in the area around the tracheostomy. If the infection is not stopped, sepsis develops
• Pneumothorax. Air enters the space around the lungs. This causes their partial or complete collapse
• Damage to the trachea. Wearing a pipe for a long time sometimes leads to damage to the walls of the throat and the development of scars. In some cases, stenosis develops
• Swallowing problems. This is due to the fact that the tracheostomy puts pressure on the esophagus
• Granulomas. They are formed in response to irritation from the catheter

To prevent the risk of complications, you must strictly follow the doctors' instructions for caring for the tracheostomy and the surrounding skin. In particular, it is necessary to regularly change bandages and monitor the cleanliness of the air that a person inhales.

Speech with tracheostomy

One of the important stages of rehabilitation of people with a tracheostomy is maintaining their speech ability. This is due to the fact that a tracheostomy makes speaking difficult: the air needed to produce sounds bypasses the vocal cords. There are ways that can help patients with tracheostomy. These include:

• Speech restoration. The process begins with the use of special tracheostomy tubes, which allow some of the exhaled air to be directed through the vocal cords. These tubes have valves that direct air to the vocal cords when you exhale, allowing you to produce sounds
• Using talking valves. This is a small device that attaches to the end of a tube. The valve opens when you inhale, allowing air to enter the lungs. It closes when you exhale, forcing air through the vocal cords. This is what allows the patient to speak
• Speech rehabilitation techniques. Working with speech therapists includes breathing exercises. These techniques help control air flow and train vocal cords and articulation. The main goal of therapy is to maximize the restoration of speech functions and improve voice quality

In addition to physical rehabilitation, patients experiencing communication difficulties due to a tracheostomy should be provided with emotional and psychological support. Support from family and friends can help them adjust to new conditions and restore self-confidence.

Tracheostomy care

Proper care helps reduce the risk of complications and promotes rapid restoration of respiratory functions. The main stages of caring for a tracheostomy are as follows:

1. Regular cleaning. To clean the skin around the tracheostomy, it is recommended to use sterile wipes or cotton swabs soaked in saline solution. To avoid causing irritation or damage, treat the skin around the tracheostomy carefully
2. Replacing the cannula. It should be changed regularly. This is usually done by a doctor, but in some cases trained family members can perform this procedure at home. Replacement involves removing the old cannula and installing a new one. The process is performed using sterile instruments and gloves
3. Air humidification. bypasses the nose and throat. The humidity of the inhaled air is not naturally regulated in the presence of a tracheostomy tube. A humidifier can help prevent your airways from drying out and becoming irritated. If available, air enters through special humidification systems connected to the pipe
4. Monitoring the condition of the tracheostomy. Regular examination can look for signs of infection, redness, swelling or unusual discharge. If any abnormalities are detected, you should immediately consult a doctor

If the tracheostomy has a speaking valve, its condition also requires regular monitoring and care (the principles are the same).

Recommendations after tracheostomy

People with a traeostomy should learn how to breathe correctly. This can be done using special deep breathing exercises. In this way, the risk of secretion stagnation in the lungs can be prevented.

It is very important to be aware of the signs of infection. These include redness, swelling, pain in the tracheostomy area, as well as fever, foul odor and unusual discharge.

After tracheostomy, it is necessary to change your diet (this is especially true if you have difficulty swallowing). If necessary, you should switch to specialized nutrition.

In order to monitor the condition of the tracheostomy after discharge from the hospital, the patient should regularly visit the doctor. This will help the specialist to respond to any changes in a timely manner.