7.8
Trachéotomie I: procédure et tubes
Une trachéotomie est une intervention chirurgicale qui consiste à créer une ouverture artificielle dans la trachée, généralement au niveau du deuxième…
La trachéotomie est une technique chirurgicale qui consiste à créer une ouverture dans la trachée pour établir une voie respiratoire perméable, contourner une obstruction des voies respiratoires supérieures, éliminer les sécrétions, permettre une ventilation mécanique à long terme et aider au sevrage du ventilateur.
Elle est généralement réalisée sous anesthésie locale ou générale dans un environnement stérile.
Une incision est pratiquée sur la partie antérieure du cou qui s’étend jusqu’à la trachée, et un tube de trachéotomie est inséré et fixé à l’aide d’une bande velcro.
Les tubes de trachéotomie peuvent être munis ou non d’un ballonnet, fenêtrés ou non.
Un tube à ballonnet est utilisé pour les patients nécessitant une ventilation mécanique, tandis qu’un tube sans ballonnet convient aux trachéostomies à long terme sans ventilation mécanique.
Un tube fenêtré a des trous dans la tige, permettant la respiration et la parole.
Ensuite, les soins postopératoires comprennent le gonflage du brassard, la confirmation de la mise en place du tube, la suture et l’application d’un pansement stérile.
Enfin, les responsabilités infirmières comprennent l’évaluation régulière du site de la trachéotomie, le changement des pansements stériles, la surveillance de la pression de gonflage du ballonnet, l’aspiration de la canule de trachéotomie et la facilitation de la communication en cas de difficultés d’élocution.
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Q1: What are the main purposes of performing a tracheostomy?
A tracheostomy establishes a patent airway when oral or nasal intubation is not possible, bypasses upper airway obstructions, and simplifies secretion removal. It enables long-term mechanical ventilation, facilitates ventilator weaning, reduces ventilator-dependent days, decreases hospital length of stay, and improves communication for patients with speech difficulties.
Q2: What are the differences between cuffed and cuffless tracheostomy tubes?
Cuffed tubes have an inflated cuff that seals the opening around the tube to prevent air leakage and aspiration, making them essential for patients requiring mechanical ventilation. Cuffless tubes lack this seal and are suitable for long-term tracheostomies without mechanical ventilation, allowing spontaneous breathing without the need for pressurized sealing.
Q3: How do fenestrated tracheostomy tubes differ from non-fenestrated tubes?
Fenestrated tubes have one or more openings in the shaft that allow patients to breathe spontaneously and speak with the tracheostomy tube in place. Non-fenestrated tubes lack these openings and are used when a complete seal is necessary, such as during mechanical ventilation or when airway protection is the primary goal.
Q4: What components make up a tracheostomy tube?
A tracheostomy tube consists of an outer cannula or main shaft, an inner cannula, and an obturator. The outer cannula is the primary tube inserted into the trachea, the inner cannula can be removed for cleaning, and the obturator guides the direction of the outer cannula during placement and must be removed immediately after insertion to keep the airway open.
Q5: What are the key nursing responsibilities for tracheostomy care?
Nursing care includes regular tracheostomy site assessment, performing sterile dressing changes every 12 to 24 hours, measuring cuff inflation pressure with a cuff manometer at least every 8 hours, and suctioning the tracheostomy tube. Nurses must also ensure patency, provide humidified air to keep secretions thin, and maintain emergency preparedness with spare tubes at the bedside.
Q6: What should be done immediately if accidental decannulation occurs?
Call for help immediately and assess the patient's level of consciousness, ability to breathe, and presence of respiratory distress. Keep a spare tracheostomy tube of the same size and one size smaller at the bedside for prompt reinsertion. Have an obturator readily available to guide the new tube safely into place, and remove it immediately after insertion to maintain airway patency.
Q7: How is a tracheostomy procedure performed and secured?
The procedure is performed in a sterile environment under local or general anesthesia. An incision is made on the anterior neck extending to the trachea, typically at the second or third cartilaginous ring level. The tracheostomy tube is inserted through the opening and secured around the patient's neck with twill tapes or a Velcro strip, then sutured with a sterile dressing applied.