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T – Tüp


t-tup-icerik

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Açıklama

The long tracheal T-tube allows for maintaining an adequate clearance in the airway. It may serve as support for the tracheal wall and in the treatment of stenosis.

It is capable of keeping this function for long periods.

T-tup T is available in three types: Standard, Tracheal tube with large thoracic branch, and Pediatric. The last one includes an external branch in a less than 90º angle to facilitate aspiration and cleaning.

The external branch of tracheal T-tubes, prevents sliding and facilitates the aspiration of bronchial secretions.
Tubo traqueal en T Largo – Montgomery
Anaesthesia:

Anaesthesia is possible through the Tracheal T-tube. The need to occlude the lumen of the upper branch to prevent the loss of anaesthetic gases should be considered. This may be achieved by inflating the balloon of a catheter which, inserted through the nasal path, should cross the vocal cords and reside inside the upper branch.

As the Tracheal T-tube lacks an inflatable balloon, positive pressure ventilation may cause a variable air reflux that will depend on the lumen existing between the tube wall and the trachea.
Insertion:
In its Standard, large or pediatric size, the Tracheal T-tube should be inserted by a trained operator.

In general, the procedure is performed in the operating room and under the general anaesthesia applied for tracheal reconstruction, but may also be performed under local anaesthesia.

Two curved forceps and an aspiration system will be required. The end of the lower branch should be folded (figure 1), the curved forceps will keep the tube in this position.

Then, the set is inserted in the distal trachea through tracheostomy.

The second forceps secures the T-tube on the external branch until the upper branch is adjusted inside the proximal trachea.

Lastly, the ring with the lid is inserted in the forceps to later take the external branch, sliding the ring until it stays close to the neck skin separated from it by gauze.

Occlude the external branch with the lid provided.
Removal:

The Tracheal T-tube may be removed by inversely following the insertion steps.  Removal may occur at the end of the treatment or it may be changed after a six-month period, approximately.

If the proximal branch used was large, removal may be performed using a straight laryngoscope or a tracheoscope, visualizing it through the vocal cords. Then the external branch will be sectioned and removed using a forceps through the tracheoscope.

Other forms of insertion and removal may be used depending on the operator’s experience and preferences.
Post-operation care:

Often perform washes and aspiration
Clean the skin around the tube two or three times a day
Keep the external branch occluded as long as possible
This allows for a more physiological respiratory function with wet secretions
Instructions may vary in each case and should be provided and adjusted by the physician treating the patient and his-her family.
In the presence of stridor, difficulty breathing or any other abnormalities, immediately consult the specialist.

Indications:

Tracheal stenosis
Tracheal resection and termino-terminal anastomosis
Trachea reconstruction
Laryngotracheal trauma

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