Tracheotomy (incision of the trachea) is carried out in cases where the natural airflow through the trachea is not possible – for tumors of the larynx, vocal cords.
Patients who undergo surgery, both before and after surgery, fear to choke. It is therefore very important to prepare the patient’s tracheostomy. Both the patient and his relatives must realize that after the operation he could not talk because of cough and breathing strifroznogo. The patient will need care for tracheostomy tubesCoy, so the patient and his family members have to learn to take care of a tracheostomy.
A patient in a permanent tracheostomy The necessityma metal tube (Fig. 24). It consists of three parts:
- the outer tube (cannula) having a side opening for ribbons which it is attached wokpyr patient’s neck;
- guide (guiding unit) from the closed end, which puts the tube in place; Applyout only with the introduction of the tube;
- inner tube (cannula), standing in traheostoma with an outer tube, can be removed for washing.
Models of the inner tube somewhat, but better use a metal tracheostomy tube having a lock-box, allowing toreliably hold the inner cannula. Constipation-FLAJoc must always be closed, or on coughing or even during washing, the inner tube may fall out of the outdoor. The outer tube ficsiruetsya ribbons around the neck, so you need to make sure that the ribbon untied Yai, otherwiseruzhnaya tube may pop out of the tracheostoma when sudden movement or coughing, resulting asfikthese (suffocation) as tracheostomy immediately closed without tubes.
The outer tube can be removed or replaced only by a doctor, an inner tube – at home whiskerloviyah trained member of the family or the patient himself. For the care of a tracheostomy patient must “cook: with sterile cloth bagmi vial with 70-degree solution of ethyl alcohol, brush, roller, bottle with sterile glycylRene, a container with two percent soda solrum (1 teaspoon to 120 ml of water);
- Remove the bandage covering the hole pipeki;
- Wash the hands;
- stand up in front of a mirror;
- turn lock-box outer tracheotomycal tube to the “up”;
- take the “ears” of the internal tracheal tube between thumb and forefinger and firmly secure them in his hand;
- lock plate outer traheotonomic tube on both sides with the other hand (sothe thumb and forefinger)
- extract of the “ears” in the direction of ourselves Dugoshaped movement of the inner tracheotomy tube from the outer tube;
- lower inner tracheal tube into the container with two percent soda solution, preheated to a temperature of 45 °;
- treat the inner tracheotomy tubesku a brush in a container with two percent soda rathe shots from the crusts and mucus (until you remove all the peel);
- Rinse the inside tracheotomy tubesku under running water;
- dry the inside tracheotomy tubesku sterile cloth;
- handle doubly inner tracheotomyical tube cloth moistened with a solution of 70 -gradusnym ethyl alcohol;
- Moisten a sterile gauze sterilenym glycerol and lubricate the outer surface of the inner tracheal tube;
- Shake before you enter it into the outer tube to her left drops of glycerine \ (drops remaining on the tube, can cause coughing); j
- lock plate outer tracheal tubes thumb and forefinger of the left hand;
- take the “ears” of the internal tracheal tube between thumb and forefinger of his right hand and put into the hole of the outer tube;
- fix the inner tracheotomy tube by moving the lock-box to the “down”;
- remove the container with water, ruff and drugs;
- Wash the hands.
Note:boil in a special emkosti 2 ruff (one – substitutes) within 30 minutes of boiling water. Drain after boilNiya, ruffs dry and wrap in a clean cloth, where it is stored until the next use.
Patient while walking in the winter period is necessary to impose on the tube hole bilayer gauze bandage and bandage should moisturize the water (Fig. 25) in the summer.
Eating the patient should be in a calm state, not talking, no laughing. It is recommended to wear a scarf, scarf or kerchief around the neck. When is it addictive Pacicient to the tube and appear confident, you can porerecommended active cover tube collar, tie. In some cases, put an inner tube with a valve that allows you to talk. This tube can be worn during the day as long as there is a need to communicate. On her nightnecessity to change an ordinary handset. patient moJet learn to talk, covering the opening of the tracheal cannula finger, wrapped with a sterile cloth. We can use this techniquebut short conversation.
To prevent drying of the mucous aboutspan of the trachea into the trachea poured into 2 – 3 drops of sterile vaseline oil or glycerol. Thinning mucus poured by pipette 0.9 ml of 1-propercentage of sodium chloride solution or 1 ml fermentha-trypsin.