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Today's article is about, “Quick Tip for Families in Intensive Care: Can a Tracheostomy be Done for a Patient with a Short Neck?”
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Quick Tip for Families in Intensive Care: Can a Tracheostomy be Done for a Patient with a Short Neck?
“Can a tracheostomy be done for a patient with a short neck?” That’s what I’m going to answer today.
My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.
This is obviously a question we get from
clients every now and then, because there are patients in ICU that have a short neck and where tracheostomy might be more challenging to be done, and it needs more forward planning.
It’s also often more resources, but let’s break this down in more detail.
So, a tracheostomy can be done in a patient with
a short neck, but it is often more technically challenging and carries a higher risk compared to patients with a normal neck length. Why is it more complicated? It’s simply limited access to the trachea.
A short or thick neck may make it difficult to palpate and visualize the trachea. There’s also some anatomical distortion. The trachea may be deeper or shifted due to obesity, swelling or anatomical
variation. Increased risk of complications including bleeding, incorrect placement or injury to surrounding structures, i.e. thyroid or major blood vessels.
So, how is it being managed? Imaging guidance, surgeons may use ultrasound or CT imaging before or during the procedure to guide the placement. A surgical tracheostomy is preferred instead of a percutaneous tracheostomy, which is done at the
bedside often by intensive care specialists.
A surgical tracheostomy in an operating room is often safer for patients with a short or challenging neck anatomy. Experienced operator, the procedure should be done by a skilled ENT (Ear, Nose and Throat) surgeon, or a surgeon with experience in complex airway anatomy and management.
Once again, most tracheostomies nowadays are done at the bedside in ICU by an intensive care specialist. In this instance with a short neck, it is done in the operating room or operating theatres by an ENT surgeon.
So, to summarize, a short neck absolutely doesn’t rule out a tracheostomy, but it does mean the care team must adjust the approach and take extra
precautions to ensure safety.
If you’re facing this decision for a loved one, it’s reasonable to ask whether ENT or any other surgeon with experience for surgical tracheostomies will be involved in whether imaging will be used to assist.
So, I hope that clarifies.
But before you’re even going towards a tracheostomy for your loved one, make sure the intensive care team has done everything beyond the shadow of a doubt that the tracheostomy can be avoided because it should be a last resort.
In order to find out whether the intensive care team is doing everything beyond the shadow of a doubt to
avoid a tracheostomy, help your loved one to get extubated in the first place, check out my article and video, “How to wean a critically ill patient of the breathing tube and the ventilator?” and I will link to the video in the written version of this blog.
I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care all around the world since 2013 here at intensivecarehotline.com. I
can very confidently say that we have saved many lives for our clients in intensive care. You can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com
podcast section where we have done client interviews.
Because our advice is absolutely life changing because we help families in intensive
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That’s
why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this
once in a lifetime situation that you can’t afford to get wrong. I also talk to doctors and nurses directly with you or on your behalf, or I’ll set you up with the right questions to ask. When I do that, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.
By doing so, you will see that the dynamic shift in your
favor very quickly. Intensive care teams are not even telling you half of what’s going on unless you dig deep and unless you know what to look for, and unless you know what questions to ask.
The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.
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Thank you so much for watching.
This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.
Take care for now.
