Najczęstsze powikłania po tracheostomii
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Najczęstsze powikłania po tracheostomii

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Zabieg tracheostomii polega na wytworzeniu przetoki pomiędzy tchawicą a skórą. Wykonuje się go w celu utrzymania drożności dróg oddechowych. Jakie są naczęstsze powikłania przy tym zabiegu?

Wśród najczęstszych powikłań po tym tracheostomii wymienia się krwawienie, przebicie ściany tylnej tchawicy, powstanie przetoki tchawiczo-przełykowej, powstanie odmy opłucnowej, śródpiersiowej, a także ropienie wokół rurki tracheostomijnej.

Jakie są wskazania do wykonania tracheostomii?

Tracheostomię wykonuje się w przypadku niedrożności górnych dróg oddechowych, rozległego urazu twarzoczaszki uniemożliwiającego intubację oraz nacieku nowotworowego zwężającego tchawicę. Zabieg ten przeprowadza się również jako forma zabezpieczenia dróg oddechowych w czasie operacji, w sytuacji kiedy nie ma możliwości intubacji dotchawiczej, a także jako przedłużona intubacja (> 8 dni).

Jak wykonuje się tracheostomię?

Tracheostomię wykonuje się w znieczuleniu ogólnym lub miejscowym. Podczas zabiegu pacjent leży na plecach z głową odchyloną do tyłu. Ważne jest tu również, aby umiejscowić chrząstkę tarczowatą i chrząstkę pierścieniowatą krtani, ponieważ nacięcie wykonuje się tuż poniżej chrząstki pierścieniowatej. Nacina się poprzecznie kilkucentymetrowy odcinek skóry, tkanki podskórnej i powięzi.

W przypadku, kiedy tarczyca dosięga 1. lub 2. chrząstki tchawiczej, przecina się wówczas jej węzinę. Następnie wycinany jest owalny otwór w tchawicy, pomiędzy 2. a 3. chrząstką pierścieniowatą.

Kolejnym etapem zabiegu jest rozszerzenie kleszczykami otworu w tchawicy oraz wprowadzenie i uszczelnienie balonem rurkę tracheostomijną. Wówczas wprowadza się do rurki cewnik, którego zadaniem jest odessanie zawartości dróg oddechowych.

Po zabiegu, który kończy się zeszyciem skóry, w plastikowych otworach rurki tracheostomijnej, które wystają nad skórą umieszcza się tasiemkę. Należy ją zawiązać na szyi, z uwzględnieniem zapasu na palec.

Źródło: Noszczyk W., Chirurgia Repetytorium, Wydanie II uaktualnione, Warszawa 2019, s. 101-103

Przeczytaj także: Jakie objawy świadczą o ostrej gastropatii krwotocznej?

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Pielęgniarstwo w Anestezjologii i Intensywnej Opiece”:

ECMO jako część nowoczesnej intensywnej terapii u pacjentów z niewydolnością oddechową

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