Temporary Tracheostomy Tubes A Practical Guide - Preview

VETcpd - Surgery Peer Reviewed

Temporary tracheostomy
tubes: a practical guide
Temporary tracheostomy involves the introduction of a tracheal cannula that will
be left in place until the airways are patent, following investigation and diagnosis
of the underlying disease. They are placed in cases of upper airway obstruction
or prior to planned surgery where dental occlusion assessment is required.
Tracheostomy tubes available for veterinary patients are manufactured for human
use and are either adult size tubes or paediatric tubes. Common complications are
obstruction, dislodgement, aspiration pneumonia and stoma swelling. The surgical
site is allowed to heal by secondary intention after tube removal.
Key words: Tracheostomy tube, temporary tracheostomy, upper airway obstruction
Nicola Kulendra
BVetMed (Hons) MVetMed
Introduction
CertVDI PGCert (Vet Ed) A temporary tracheostomy tube is placed Brachycephalic patients, in particular, are
DipECVS FHEA MRCVS in cases of upper airway obstruction or for likely to be hyperthermic and can be
European and RCVS Specialist planned surgeries of the upper airway such cooled using a fan, via the provision of
in Small Animal Surgery as those where dental occlusion assessment intravenous fluid therapy, or, in more
is required. They are most commonly severe cases, by placing wet towels over
Nicola graduated from The Royal placed for cases of marked trauma to the patient. Care should be taken to
Veterinary College in 2006 and worked the upper airway, severe brachycephalic ensure the patient does not become too
for 12 months in general practice. She obstructive airway syndrome (BOAS), cold as cooling continues beyond the
returned to the RVC in 2007 as Junior anaphylaxis or laryngeal trauma/paralysis removal of active measures. In cases of
Clinical Training Scholar (intern). After prior to definitive surgery (tieback). severe upper airway inflammation the
another year in practice in Caterham Other indications include severe laryngeal administration of a corticosteroid may
she obtained the position of a Senior inflammation, neoplasia and foreign body. be indicated.
Clinical Training Scholar (Resident) in Tracheostomy tubes can also be placed
Small Animal Surgery in 2009. Nicola as an ancillary procedure to prevent
passed the board certifying examination postoperative dyspnoea after extensive
of the European College of Veterinary
surgical procedures on the pharynx or
Surgeons (ECVS) in 2013 and is now
larynx or to stabilise the patient facilitating
a European Specialist in Small Animal
transportation for referral. Temporary
Surgery. She has also completed a
tracheostomy includes the introduction of
clinical masters programme (MVetMed)
and obtained her certificate in Veterinary
a tracheal cannula that will be left in place
Diagnostic Imaging (CertVDI) in 2011. until the airways are patent following
diagnosis and treatment of the underlying
condition as indicated. Contraindications
to placement are tracheal obstruction or
collapse distal to the tracheostomy site,
previous tracheal stent placement and the
A
presence of coagulopathies.
Initial stabilisation of patients with
upper respiratory signs includes oxygen
supplementation, which can be provided
via a mask although an oxygen tent may
be more appropriate for feline patients
(Figure 1). Sedation using butorphanol
(0.1-0.2mg/kg iv or i/m), with the
addition of acepromazine (0.001-
0.002mg/kg i/v or i/m) if required,
reduces distress without significantly
Subscribe to VetCPD Journal compromising ventilation. In the patient
with upper respiratory tract signs B
Call us on 01225 445561 sedation can result in a significant clinical
Figure 1: Oxygen supplementation can be given
or visit www.vetcpd.co.uk improvement and also facilitates more via flow by (A) or via a mask (B) if tolerated.
comprehensive physical examination. Image courtesy of Kieran Borgeat.

Page 52 - VETcpd - Vol 5 - Issue 2

VETcpd - Surgery
Box 1: Tracheostomy Tube

An emergency tracheostomy kit Selection
should include the following items, Tracheostomy tubes are all human
be frequently checked and updated sized tubes. There are two types of
and be readily available: tracheostomy tubes, human adult sized
tubes, which have an inner cannula
• IV cannulas and T connectors
that can be removed and cleaned and
• Induction agent paediatric tubes, which have no inner
• IV needles and syringes cannula (Figure 3). Tubes with an inner
cannula that can be removed and cleaned
• A selection of tracheostomy tubes
are preferred. Tube size is decided on a
• A basic surgical kit including case-by-case basis and is roughly related to Figure 3a: Adult tracheostomy tubes have a
rigid stylette to aid placement as well as inner
Gelpi retractors endotracheal tube size. During placement, cannulas. The inner cannulas are placed when
• Umbilical tape to secure the tube a tube is selected which is approximately the dog is awake and can be easily removed to
40% of the diameter of the trachea (Figure facilitate cleaning.
• 3M PDS
4). A larger tube will increase the luminal
• 2M PDS airflow (Poiseuille’s Law) and is less likely
to become obstructed. However, a large
tube takes up a greater area of the trachea
Although most tracheostomy tubes and, should the tube become obstructed,
are placed in emergency situations, the animal is more likely to suffer a fatal
it is usually possible to place an IV airway obstruction as there is less airflow
cannula, induce anaesthesia and place around the tube.
an endotracheal (ET) tube allowing the
procedure to be performed under general
anaesthesia and sterile conditions. It is
Cricothyroid
useful to have an emergency tracheostomy muscle
kit with all elements ready in case of such Figure 3b: Paediatric tracheostomy tubes
have an inner rigid stylette, which is used
emergencies (Box 1). Internal during placement but must be removed before
In patients where endotracheal intubation jugular vein connecting to the anaesthetic circuit.
is very challenging the Seldinger technique
can be helpful. A laryngoscope is used
to visualise the larynx and a urinary
catheter or guide wire is inserted through
the larynx. Oxygen can be temporarily
administered via the urinary catheter. The
ET tube is then passed over the catheter
or guide wire. An endoscope can also be
used to visualise placement of the guide
wire and retrograde placement of a guide
wire via the cricothyroid membrane into
the oropharynx and out of the mouth
Figure 3c: This English Bulldog weighed 32kg
may also facilitate ET tube placement.
but the size of the trachea meant that a paediatric
tracheostomy could be placed. Management was
Anatomy and physiology challenging as the tube was relatively short for
the size of his neck.
of the trachea (Figure 2)
Vascular branches to the trachea are
Trachea
supplied by the cranial and caudal thyroid
arteries and veins, bronchoesophageal Recurrent
arteries and veins, and the internal jugular laryngeal
veins. Innervation is via the autonomic nerve
nervous system. Sympathetic fibres
from the middle cervical ganglion and Common
sympathetic trunk inhibit tracheal muscle carotid artery
Trachea
contraction and glandular secretions,
while parasympathetic fibres from the
vagus and recurrent laryngeal nerves sternohyoid muscle
Tube
cause tracheal muscle contraction and
glandular secretions. Figure 2: The anatomy of the trachea Figure 4: Schematic illustrating the ideal size of tube
and associated structures. required to complement the lumen of the trachea.
VETcpd - Vol 5 - Issue 2 - Page 53

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VETcpd - Surgery Peer Reviewed

Page 52 - VETcpd - Vol 5 - Issue 2

Box 1: Tracheostomy Tube

VETcpd - Vol 5 - Issue 2 - Page 53

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