Which of the following statements concerning tracheostomies is true?
|A||The proper location for a tracheotomy is just below the fourth tracheal ring|
|B||Tracheal stenosis usually does not occur at the stomal site|
|C||If stenosis occurs, no more than 2.5 cm of trachea can be resected and still permit end-to-end reanastomosis|
|D||Tracheo innominate artery fistulas can be treated by ligation and division of the innominate artery|
a. The performance of an open tracheostomy is more varied.
b. The awake patient does not tolerate this; therefore, the procedure is performed with the patient in a sitting or semirecumbent position.
c. Overextension of the neck should be avoided because it further narrows the airway.
d. T-shaped tracheal opening: Make a 2-cm incision horizontally through the membrane between the second and third or third and fourth tracheal rings.
e. Stenosis: Injury to the cricoid cartilage, the only circumferential ring in the trachea, can lead to laryngeal stenosis. Stenosis typically occurs at the site of the tracheostomy or at the area irritated by the cuff.
f. Bleeding more than 48 hours after the procedure may herald a tracheoinnominate fistula caused by a low (farther along the trachea toward the carinA. tracheostomy or an ill-fitting long tube.
g. One half of patients with significant bleeding more than 48 hours after the procedure have a tracheoinnominate erosion
h. Patients with an impending tracheoinnominate fistula may have a sentinel bleed (ie, brief episode of brisk bright red blood from the tracheostomy sitE. hours or days before catastrophic bleeding.
i. If diagnosis is made only when catastrophic bleeding occurs, management includes replacement of the tracheostomy tube with an endotracheal tube with the balloon inflated distally to the site of the bleeding to protect the airway. If the balloon does not tamponade the bleeding, a well-placed finger can temporize while the thoracic surgery team mobilizes for median sternotomy to locate and to control the bleeding vessel.