Tracheal stoma stents or tracheostomy buttons are used to maintain stomal patency. This provides access for suctioning or replacement of a tracheostomy tube for emergency ventilation (Figure 38-4). The closure plug on the button allows for normal respiration and phonation. Several designs of stomal stent are available (Figure 38-5), including the Montgomery tracheal cannula system, made of silicone (Boston Medical Products, Inc.), the Olympic tracheostomy button made of Teflon (Olympic Medical, Seattle, WA),20 and the straight and curved stents made of silicone (Hood Laboratories, Pembroke, MA) (see Figure 38-4). Each manufacturer provides a wide range of sizes and lengths, and thus, these devices can be adapted to fit most pathological situations in any patient. Before a stomal stent is placed, the patient's swallowing function must be evaluated. In addition, a chest x-ray should be obtained to confirm the absence of progressive parenchymal disease. The inspired oxygen requirement should be no greater than 40%.
Prior to placement of a stomal stent, the tracheostomy tube is removed. The stomal depth is measured by placing a sterile small hooked pipe cleaner, or a device called a stoma gauge (Hood Laboratories), figure 38-4 Stomal stent is available in both curved and straight designs (Hood Stoma Stent, Hood Laboratories, Pembroke, MA). Both designs are available in several diameters (A) and lengths (B).
figure 38-4 Stomal stent is available in both curved and straight designs (Hood Stoma Stent, Hood Laboratories, Pembroke, MA). Both designs are available in several diameters (A) and lengths (B).
into the stoma and hooking the anterior tracheal wall (Figure 38-6). The length is marked at the skin surface. The length of the stent is determined using this measurement. The length of stomal stent must not exceed that of the stomal track, otherwise the stent can slip backward into the trachea, causing obstruction of the airway. The stent is lubricated and placed into the stoma, and then the closure plug is inserted. The patient should be encouraged to cough, breathe deeply, and talk using normal glottic function. The closure plug should be removed, and a light source used to ensure that no obstruction exists around the pedicles of the stent against the anterior tracheal wall. If the stomal stent protrudes, then the closure plug is removed and gentle pressure is applied to reposition the stent flush with the neck. Improper positioning may limit function and increase the risk that the stent is only partially in the stoma and that the anterior tracheal wall will close. Stomal stents may be left in place for several days or weeks. Complications are primarily related to malpositioning. Many patients go home with an appliance in place.
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