10/17/2009

Pengertian TRAKEOSTOMI
Trakestomi adalah tindakan mebuat lubang pada dinding depan/anterior trakea untuk bernapas

OLEH FAHRUN NUR ROSYID

Pembagian trakeostomi
Menurut letak stoma : Letak yang tinggi dan letak yang rendah batas letak adalah cincin trakea ke tiga Menurut waktu tindakan Trakestomi darurat Trakestomi berencana

Indikasi Trakeostomi
Mengatasi obstruksi laring Mengurangi ruang rugi (dead air space) di saluran napas atas (rongga mulut, sekitar lidah dan faring) Mempermudah penghisapan sekret dari bronkus pada pasien yang tidak dapat mengeluarkan secara fisiologik (pasien koma) Untuk memasang respirator Untuk mengambil benda asing dari subglotik, apabila tidak mempunyai fasilitas untuk bronkoskopi

Alat-alat trakeostomi
Semprit dengan obat analgesia (novokain) Pisau (skalpel) Pinset anatomi Gunting panjang yang tumpul Sepasang pengait yang tumpul Klem arteri Gunting kecil yang tajam Kanul trakea dengan ukuran yang cocok

Teknik trakeotomi

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A horizontal skin incision is marked midway between the cricoid cartilage and the sternal notch. The skin is infiltrated with XylocaineEpinephrine to decrease the bleeding.

The skin incision is made with a Colorado Needle mounted on an electric knife (Bovie). A steel blade scalpel is as good and is preferred by many surgeons.

After incising the subcutaneous tissue and platysma, the strap muscles are separated in the midline. The strap muscles is a name given to the four infrahyoid muscles that lie in front of the larynx. They are the sternohyoid, sternothyroid, thyrohyoid and the omohyoid.

The isthmus of the thyroid gland is either retracted or divided in the midline. (In this picture, the isthmus has been divided and retracted laterally, along with the strap muscles.) The anterior tracheal wall is divided between the third and fourth tracheal rings. A clamp is used to widen the tracheal opening. The endotracheal tube is seen inside the tracheal lumen.

The tracheal wall incision is extended downward, bilaterally to form a "trapdoor" flap. The flap is everted with an Allis clamp.

A silk suture is used to retract the trapdoor flap, making it easier to insert the tracheostomy cannula, and preventing it from going through a false passage into the mediastinum.

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While pulling on the silk suture to retract the trapdoor flap, the tracheotomy cannula, with its cuff deflated, is inserted into the lumen of the trachea.

The cannula is sutured to the skin. An "accordeon" Racine adaptor is placed on the cannula and connected to the anesthesia circuit.

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A piece of Xeroform gauze is slit and placed around the tracheostomy Cannula. Other tracheostomy dressigs are available and would do just as well.

Umbilical tape is inserted into the slots of the cannula and tied.

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Side view of the "accordeon" adapter that connects to the anesthesia circuit. (The patient's head is to the right side of the picture)

To prevent a tight fit around the neck, the umbilical tape is tied over a finger, while the neck is flexed.

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Perawatan Pasca Trakeostomi

Penting, karena sekret dapat menyumpat Sekret di trakea dan kanul harus sering dihisap keluar Kanul dalam dicuci sekurang-kurangnya 2 kali sehari Lalu segera masukkan lagi ke dalam kanul luar Bila kanul harus dipasang dalam jangka ewaktu yang lama, maka kanul luar harus dibersihkan 2 minggu sekali Kain kasa dibawah kanul harus diganti setiap basah, untuk menghindari dermatitis