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Human Anatomical Specimens - Complications of Tracheostomy

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Human Anatomical Specimens - Complications of Tracheostomy

release date:2021-12-29 author: Click:

Human Anatomical Specimens - Complications of Tracheostomy

A series of complications can occur during each stage of tracheostomy. These complications are closely related to the type of surgery, age, surgical method, primary disease and postoperative care. Common complications are:

(1) Subcutaneous emphysema is the most common. Subcutaneous emphysema mostly occurs in the neck, but can also extend to the face, chest, abdomen and even the perineum. The symptoms are local swelling, which thickens when the neck occurs, and feels like holding snow when touched. Auscultation has crepitus or small plosives. Most of the causes are excessive soft tissue separation during surgery, too large tracheotomy and too tight wound suture, etc. During inhalation, the negative pressure in the thoracic cavity acts on the gas into the subcutaneous through the incision. It can also spread to the neck by mediastinal emphysema. It should be noted that subcutaneous emphysema often co-occurs with mediastinal emphysema and pneumothorax. If the cannula is unobstructed after tracheotomy and the patient's dyspnea is still not relieved, chest X-rays should be taken in time, and appropriate treatment should be given according to the disease situation. Subcutaneous emphysema generally does not require special treatment. The suture should be removed and the wound should be opened due to the tight suture of the wound of the nurse model. Mild subcutaneous emphysema usually resolves on its own within a week or so.

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(2) For pneumothorax, the top of the right pleura is higher, especially in children's semi-physical and pulmonary resuscitation simulator. If the surgical separation is to the right and the position is low, it is easy to injure the pleural roof and cause pneumothorax. If both pleural roofs are damaged, bilateral pneumothorax is formed, and the patient can die immediately. The symptoms of pneumothorax are more obvious, such as dyspnea, thoracic hypokinesis, low breath sounds on auscultation, tympanic percussion, and contralateral displacement of the cardiac dullness boundary. Taking X-rays can confirm the diagnosis. Mild pneumothorax can be closely observed. Tension pneumothorax should immediately use a thicker needle for thoracentesis to extract air or perform closed thoracic drainage.

(3) Mediastinal gas species, which are more common in children. Mostly due to excessive stripping of the pretracheal fascia. Severe breathing difficulties and a cough are more likely to occur. If the parietal pleura of the mediastinum ruptures, mediastinal emphysema can be converted to pneumothorax. The severity of mediastinal emphysema varies greatly. Mild symptoms are not obvious, generally have chest pain. In severe cases, shortness of breath, low and distant heart sounds on auscultation, and unclear boundaries of cardiac dullness on percussion. X-ray examination showed widening of the mediastinum, and lateral imaging showed streaks of air in the tissue between the heart and the chest wall. Mild mediastinal emphysema does not require treatment. Severe emphysema has mediastinal compression symptoms and affects, and decompression should be performed to release gas when it affects breathing and circulation.

(4) Bleeding, which can be divided into early bleeding and middle and late bleeding. Early hemorrhage, also known as primary hemorrhage, mostly occurs in the anterior jugular vein and thyroid isthmus due to insufficient hemostasis during surgery. In obstructive dyspnea, due to poor venous return, vascular engorgement is prone to bleeding. Some patients treated with anticoagulant drugs such as heparin due to the primary disease may cause diffuse oozing during the operation. A small amount of bleeding can be stopped by local compression. Those who bleed a lot should reopen the wound to stop the bleeding and prevent the blood from flowing into the respiratory tract and causing suffocation. Those who use anticoagulant drugs should re-operate 24 hours after stopping the drug. Middle and late bleeding, also known as secondary bleeding. It usually occurs 6-10 days after the operation, and it also occurs from one month to several months after the operation. A small amount of bleeding is mostly caused by wound infection and granulation tissue hyperplasia in the human body model. But sometimes a small amount of bleeding can be a precursor to a major fatal bleeding. Most of the fatal hemorrhages are due to the compression of the distal end of the tracheal cannula to damage the anterior tracheal wall and the wall of the innominate artery, coupled with the erosion and rupture of the innominate artery caused by infection, resulting in massive hemorrhage. The innominate artery is the largest branch of the aortic arch. After the top of the aortic arch emerges, it ascends and backwards, crosses the anterior wall of the trachea at the 7th to 8th tracheal rings, and approaches the trachea obliquely, with only a small amount of connective tissue in between. The position of the innominate artery in children is high, often beyond the upper thoracic opening. The relationship between the tracheal cannula and the innominate artery was measured after tracheotomy in 10 cadavers. He believes that if the tracheal cannula is placed below the fifth tracheal ring, the concave surface of the cannula can directly stimulate the innominate artery and cause rupture; at the same time, he pointed out that the most likely reason for the rupture of the innominate artery is that the pressure of the tracheal cannula balloon is equivalent to that of the trachea. The average perfusion pressure of the mucosal capillaries, so it can affect the blood supply and cause direct irritation or infection of the innominate artery after corrosion of the anterior wall of the trachea. Therefore, when the tracheotomy is performed, the head is too tilted to cause the incision door to be too low; the tracheal cannula used is too thick, too long, and the curvature is too large; systemic malnutrition, vascular malformations, patients can cause abrasion of the anterior tracheal wall, and vascular erosion. Fatal hemorrhage.

Prevention of fatal bleeding should pay attention to:

①The position of tracheotomy should not be too low, not lower than 5-6 rings;

② Minimize the separation of the anterior soft tissue of the trachea to avoid damage to the blood supply of the anterior wall;

③Choose an appropriate tracheal cannula. If the cannula is pulsating in the trachea, the position of the tracheal cannula should be adjusted, or a shorter cannula should be replaced. The tube should be replaced immediately;

④ For those who use a tracheal cannula with a balloon, the balloon should be released intermittently to prevent tracheal ischemia, infection and necrosis;

⑤ strive for early extubation. In the event of massive bleeding, an endotracheal tube with a balloon can be inserted first and the balloon can be inflated. Aspirate the blood and secretions in the trachea to keep the airway open. Then use your fingers and dressing to temporarily stop the bleeding. At the same time, it was moved into the operating room, and the thoracic department was asked to assist in splitting the sternum to reveal the mediastinum. Carefully search for the rupture of the innominate artery, suture it, and reinforce the suture with the nearby soft tissue.






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