Tracheostomy

Tracheostomy is an operative procedure which consists of making an incision in front of the neck and opening a direct airway through an incision in the anterior trachea through which tracheostomy tube is inserted which allows the person to breathe directly bypassing the nose, mouth and voice box.

Indications

• Prolonged ventilatory support
  • Adults- 7 – 10 days        
• • Paediatric- 4 weeks
  • Neonates- 3 months
  • (or earlier if the treating doctor feels that the patient’s condition requires prolonged ventilation)
• Bronchial toilet
• To bypass upper airway obstruction
• As an adjunct to major head and neck surgeries

Tracheostomy Tube Types

• Cuffed/ Uncuffed
• Fenestrated/ non- fenestrated/ variable length
• Single lumen/ double lumen
• Metallic/ non-metallic

Tracheostomy Home Care:

DO’s:

• Always wash your hands before and after handling the tracheostomy tube.
• Always place wet gauze soaked in saline over the outer cannula.
• Keep steaming kettle nearby to maintain the humidity in the inspired air.
• To do steam inhalation thrice daily, to keep the trachea humidified.
• Always cover the tracheostomy stoma with a thin cotton cloth to avoid the entry of dust or insects.
• Cough out the sputum or secretions after removing the inner cannula, when you feel sensation of obsruction in the airway.
• Suction apparatus to kept bedside and suctioning to be done 3 or 4 times a day or more often if required.
• Suctioning to be applied while withdrawing the catheter, never more than 10 seconds at  a time.
• If the doctor has instructed to keep the cuff inflated, then :
  • To inflate the cuff with 5-10cc air.
  • To deflate every 2 hours for 5 minutes.
  • To always inflate cuff before feeding.
• In case of sudden respiratory difficulty, remove the inner cannula and contact the nearby doctor.
• Clean, dry and apply antimicrobial ointment to the stoma 3 times a day. Change the tie around the neck when it is wet,dirty or frayed.
• You should be able to eat without any problem. If any food or liquid goes into the tracheostomy tube, cough it out right away.
• Encourage to speak by closing the inner cannula with hand.
• Always keep a calling bell or an alarm by the side of the patient.
• Always carry paper and pen to communicate.
• Follow breathing exercises (deep inspiration and expiration ) and breath holding exercises regularly.
• Visit the treating doctor regularly, atleast once in a month for follow up.
• Take plenty of oral fluids to maintain hydration.
• Wear clothes with loose necks/ collars. 
• Get both outer and inner tube changed to a new set once in 6 months.

DONT’s:

• Avoid sitting or sleeping directly under the fan.
• Do not do any tracheostomy care immediately after eating unless you have to.
• Avoid taking head bath or swimming in the pool.
• Avoid water falling directly over the stoma.
• Do not remove outer cannula unless specifically trained to do so.
• Do not keep cotton around the stoma.

How is TB Lymphadenitis diagnosed?

The diagnosis of TB lymphadenitis is typically made through a combination of physical examination, medical history, and laboratory tests.

• A fine-needle aspiration cytology (FNAC) may be performed to collect a sample of the lymph node tissue for further testing. The sample is then analyzed under a microscope to look for the presence of tuberculosis bacteria.
• CT scan of neck