Читать книгу Manual of Equine Anesthesia and Analgesia - Группа авторов - Страница 272

 The horse should be administered a tetanus toxoid vaccination, if it has not received one within the previous year.It should be administered a tetanus toxoid vaccination and tetanus antitoxin if it has never been vaccinated against tetanus.

 The horse should be administered a broad‐spectrum antibiotic until the tracheal wound begins to develop granulation tissue, usually at five to six days.

 Compressing the tissue at the site of tracheostomy by securing the tracheostomy tube with an elastic adhesive bandage applied around the neck and faceplate, leaving the entrance to the cannula uncovered, may decrease the severity of subcutaneous emphysema, which frequently develops at the site.Figure 4.16 To ease daily insertion of a tracheostomy tube, a crescent‐shaped section of cartilage can be excised from the distal aspect of the ring proximal to the incision through the annular ligament of the trachea, and a similarly shaped section of cartilage can be removed from the proximal aspect of the adjacent ring.Source: Courtesy of Dr. Peter Rakestraw, VMD, Dip ACVS.Figure 4.17 Compressing the faceplate of the tracheostomy tube against the tracheal incision diminishes the likelihood of the horse developing excessive subcutaneous emphysema adjacent to the incision.

 The tracheostomy tube should be cleaned or replaced with a clean tracheostomy tube, preferably twice daily. More frequent cleaning or replacement may be necessary if the cannula accumulates exudate rapidly.A clean tube should be inserted as soon as the soiled tube is removed, if the horse is totally dependent on the tracheostomy to breath.

 The necessity for maintaining a tracheostomy tube can be evaluated by sealing the opening of the tube with tape and evaluating how the horse breaths. Note: Even if the airway proximal to the tube is no longer obstructed, the horse may have difficulty breathing when the opening is sealed, if the tube is so large that an adequate volume of air cannot move around it. This is more likely to happen if the patient is a foal or a miniature horse.

 The wound heals rapidly by second intention after the tube is removed.A tracheostomy that has developed granulation tissue is likely to be healed between two and three weeks after the tube is removed.A thin epithelial scar is often present at the healed site of the temporary tracheostomy.

 The wound should be cleaned of exudate once or twice daily. Petroleum jelly should be applied to the skin around the wound, after the wound has been cleaned, to make subsequent cleaning easier.Avoid using soap on the wound.Avoid introducing fluid into the tracheal lumen while cleaning the wound.