Indications
Question: Can you think of situations when intubation of the stoma is indicated?
Answer: Intubation of the stoma secures the airway and facilitates positive pressure ventilation. The remaining trachea is much shorter however and so a short tube is required. This can be a standard tracheostomy tube, but remember to communicate clearly that this is a tracheostomy tube in a laryngectomy stoma, especially if the tube will remain in situ post-operatively. Specialist tubes such as the Montadon or 'hockey stick' tube (Fig 1) allow intubation with a short length in the trachea, but also take the external part of the tube away from the neck. This is useful for head and neck procedures. A standard tracheal tube can also be used, although care must be taken not to advance to or beyond the carina. The external part of the tube will likely stick straight up out of the stoma and may cause problems in securing the airway. If the patient has a TEP valve and the stoma has been intubated, the position of the valve should be checked by an ENT medic or specialist nurse post operatively. The valve may rotate or become displaced.
Fig 2 is an image of John with a dressed tracheostomy tube in his laryngectomy stoma. You can see how confusion can arise if we don't communicate clearly, especially if the patient is unconscious and can't tell you themselves.
Question: Can you think of situations when intubation of the stoma is indicated?
Answer: Intubation of the stoma secures the airway and facilitates positive pressure ventilation. The remaining trachea is much shorter however and so a short tube is required. This can be a standard tracheostomy tube, but remember to communicate clearly that this is a tracheostomy tube in a laryngectomy stoma, especially if the tube will remain in situ post-operatively. Specialist tubes such as the Montadon or 'hockey stick' tube (Fig 1) allow intubation with a short length in the trachea, but also take the external part of the tube away from the neck. This is useful for head and neck procedures. A standard tracheal tube can also be used, although care must be taken not to advance to or beyond the carina. The external part of the tube will likely stick straight up out of the stoma and may cause problems in securing the airway. If the patient has a TEP valve and the stoma has been intubated, the position of the valve should be checked by an ENT medic or specialist nurse post operatively. The valve may rotate or become displaced.
Fig 2 is an image of John with a dressed tracheostomy tube in his laryngectomy stoma. You can see how confusion can arise if we don't communicate clearly, especially if the patient is unconscious and can't tell you themselves.
