Transtracheal Aspiration - Procedure, Indications, and Risk Factors

Introduction:

The secretions present in the bronchial tube are obtained during trans-tracheal aspiration. The type of respiratory infection can be determined with the help of transtracheal aspiration. It is particularly useful when the diagnosis cannot be confirmed using sputum culture. In the sputum culture, the sample obtained is contaminated with the infectious agent present in the mouth and food pipe. The sample also consists of saliva, which has the least diagnostic significance. But during the collection of the specimen in transtracheal aspiration, the bacteria is obtained without any disruption. It also prevents the contamination of the secretion with saliva during the procedure. Transtracheal aspiration is a simple and safest technique.

What Are the Indications for Transtracheal Aspiration?

The various indications for transtracheal aspirations are as follows:

• Pneumonia - The sputum from the patient obtained contains bacteria responsible for pneumonia. It is cultured using transtracheal aspiration.

• Ventilator-Associated Pneumonia - Patient who faces breathing difficulty due to pneumonia are supported with artificial ventilation. It is difficult to administer a bronchoscope and diagnose such patients. So transtracheal aspiration is used for patients with ventilator-associated pneumonia.

• Neonates - Premature babies have underdeveloped lungs called lung dysplasia and are prone to respiratory infections. Transtracheal aspiration can be used to diagnose the condition.

• Lung Lavage - Transtracheal aspiration can be used for therapeutic benefits like removing the abnormal fluid present in the lungs. The necrotic debris due to microbial infection in conditions like lung abscesses can also be removed.

• Antibiotic Agent - Some patients with respiratory illness are resistant to certain medications due to the bacteria. In such conditions, transtracheal aspiration can be used by the medical professional to determine the type of infection and prescribe the medications accordingly.

• Respiratory Distress Syndrome - It is more commonly seen in newborns. They require ventilator support. Transtracheal aspiration can be used to determine the cause by examining the sample.

• Bronchiectasis - It occurs due to infection in the lungs, and there is a mucus discharge. Transtracheal aspiration can be done to confirm the diagnosis in patients who are suspected of bronchiectasis.

How to Prepare for Transtracheal Aspiration?

• Inform the medical professional about the past medical history before the trans tracheal aspiration.

• If there was any gag reflex during intubation in the past should be reported to the medical professional earlier so that an anesthetic spray can be used.

• Avoid smoking for at least a month before trans tracheal aspiration.

• Avoid food and liquids for eight hours before the transtracheal aspiration procedure.

• Images of lungs and air passages are obtained using computed tomography and chest X-rays. It is used to observe the condition of these structures before trans-tracheal aspirations.

How Is Transtracheal Aspiration Performed?

Transtracheal aspiration is an invasive procedure that is performed under conscious sedation.

• The neck is kept extended to carry out the transtracheal aspiration procedure.

• The area is cleaned with an antiseptic solution.

• An incision is made in the neck, and a catheter is inserted.

• The needle is inserted into the windpipe. The syringe is attached to the tube during the procedure.

• The patient is asked to cough after the needle insertion.

• Now suctioning is done using the tube. This procedure is repeated until the required amount of sample is obtained.

• If the secretion is not adequate, then saline is injected into the tube and suctioned immediately.

• The patient should continue coughing voluntarily until the sample is obtained.

• The suction tube should be sterile to avoid contamination of the sample.

• The patient is also asked to split the sputum in another tube.

• The needle is removed after transtracheal aspiration, and pressure is applied to the area for about five to ten minutes.

• After transtracheal aspiration, a dressing is placed over the incised area.

• The sample obtained from the suction tube and expectorated sputum are sent to the laboratory for analysis. It is sent immediately after the procedure.

• Culture tests are done, and the organisms are determined by routine microscopic examination.

What Are the Instructions to Follow After Transtracheal Aspiration?

Transtracheal aspiration does not require any massive equipment. So it can be carried out at the bedside of patients.

• The patients are kept under observation for a day after trans tracheal aspiration.

• Avoid flexing the neck during exercise or any other activity.

• Keep the head in an upright position while sleeping for two to three days.

• The medical professional will prescribe antibiotics and lozenges after transtracheal aspiration to prevent respiratory infection and discomfort in the throat, respectively.

• Keep the incised area clean and consult the doctor for review after two days.

• Avoid wearing a tight dress to prevent friction in the neck.

• The patient should stay in a ventilated area after transtracheal aspiration to prevent suffocation.

• Avoid blowing one’s nose or vigorous cough after trans tracheal aspiration.

What Are the Risk Factors for Transtracheal Aspiration?

After the transtracheal aspiration, the following risk factors can occur;

• Hemorrhage - There may be excess bleeding near the incised site or internal bleeding due to the rupture of any blood vessel during trans-tracheal aspiration.

• Subcutaneous Emphysema - Since it is an open surgery, there is a chance of air entrapment during the procedure. It results in subcutaneous emphysema after trans tracheal aspiration.

• Cardiac Arrhythmia - In very rare cases, there may be an irregular heartbeat after trans tracheal aspiration.

• Hemoptysis - Blood streaks may be present in expectorant after trans tracheal aspiration. In such conditions, the patient must admit to the emergency immediately.

Conclusion

The results of transtracheal aspiration can be obtained rapidly and accurately. The healthcare provider will compress the area to prevent subcutaneous emphysema. It is a transient condition and can be recovered after a few minutes. Recent studies have shown that the mortality rate after transtracheal aspiration is very low. Bronchoscopy will not eliminate the secretion completely because the tip of the bronchoscope might contaminate the mucosa in the air passages. It also makes the patient uncomfortable due to the repeated application of a bronchoscope for the removal of secretion. It can be overcome by the use of trans-tracheal aspiration. The healing of the incised site is faster in trans-tracheal aspiration. It is not suitable for patients with neck deformities. Transtracheal aspiration is not advised for cardiac patients.