Tracheo Esophageal Fistula (TEF)
Case Report
Tracheo Esophageal Fistula (TEF)
Case Report
1) sociodemographic data: Patient name: Ahmed Mohamed Alaa
Age:
1.5 month
Sex:
Male
Diagnosis:
TEF
Date of admission: 2/7/2017
Unit:
surgical ICU
2) patient history: Ahmed Mohamed Alaa,1.5 month ,2kg, diagnosed as TEF at
birth. With esophagostomy with continuous drain of mucous.
And gastrostomy tube for feeding, intubated with 3.5 noncuffed tube, mechanically ventilated at A/C MOOD. have CVC
3-Present history:
Post-operative pt. with gastrostomy tube
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in jugular vein and urinary catheter.
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4- Growth Measurement:
Weight:
Height:
HC:
CC:
2 kg
50 cm
34 cm
30 cm
5- Medication:
Averozolid
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2
syrup
1/1
antibiotic
Losec
vial
1/1
Proton pump inhibitor
Diflucan
Vial
1/1
Anti-fungal
Konakion
ampule
1/1
Anti-hemorrhage
Unacin
vial
1/3
antibiotic
Clavoran
vial
1/2
antibiotic
6- ABG interpretation:
PH
PACO2
HCO3
SO2
NA
K
7.634
27.6
28.6
91.9%
131.7
1.98
Interpretation:
 PH: alkaline
 Paco2: respiratory alkalosis
 Hco3: normal
Uncompensatory respiratory alkalosis
7- Preset Ventilator parameter:
Mood:
A/C Mood
Fio2
100%
PEEP
15
RR
45 B/M
I: E Ratio
Minute ventilation
1:2.9
68.3
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Tracheoesophageal Fistula
tracheoesophageal fistula and Esophageal Atresia are the malformation of
digestive system, in which esophagus does not develop properly. The esophagus
is a tube that normally carries food from the mouth to stomach.
Esophageal Atresia: the failure of esophagus to form a continuous passage
from the pharynx to the stomach.
Tracheo-esophageal fistula: an abnormal connection between the trachea
and the esophagus.
Epidemiology
 occurs in 1 in 3500 births.
 slight male dominance.
 common in prematurity 34%
 50% with associated anomalies.
Etiology:
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Still unknown cause
Types:
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Clinical presentation:
1.
Drooling.
2.
Regurgitation.
3.
Coughing.
4.
Choking
5.
Scaphoid abdomen = EA
6.
Distended abdomen = TEF
7.
Cyanotic episodes
8.
Inability to pass OGT
9.
Pneumonia, atelectasis
3C = coughing, choking, cyanosis
Diagnosis
 Prenatal:
1. Ultrasound = polyhydramnios, absent stomach
2. MRI = blind distended esophageal pouch
 TEF may be detected postnatally by:
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1. X-ray taken with radiopaque catheter placed in esophagus to
check for obstruction; standard chest X- ray shows a dilated
air-filled upper esophageal pouch and can demonstrate
pneumonia.
2. Inability to pass a NG tube into stomach because it meets
resistance
3. Bronchoscopy
esophagus
visualizes
fistula
between
trachea
and
4. Abdominal ultrasound and echocardiogram to check for cardiac
abnormalities.
Associated anomalies:
•
VACTERRL
•
Vertebral, Anorectal, Cardiac, Tracheoesophageal, Radial,
Renal, Limb
•
Trisomy 18 + 21
•
Laryngotracheal esophageal cleft
•
Failure of fusion of laryngtracheal groove
Management:
The management of trachea- esophageal fistula is mainly surgical. Surgical
intervention depends on the distance between proximal and distal pouch of
esophagus, type of defect, condition of neonate and his weight.
Nursing management:
NPO
2.
Avoid bag-mask ventilation
3.
45° head up
4.
Low continuous suctioning of esophageal pouch
5.
IV fluid
6.
VitK, TPN as needed
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1.
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Nursing diagnosis
Pre-Operative:
1. Risk for aspiration related to structural abnormality.
2. Risk for deficient fluid volume related to inability to take oral feeds.
3. Impaired breathing related to frequent laryngospasm and excessive
secretions in the trachea.
Post-Operative:
1. Ineffective airway clearance related to disease process
2. Impaired nutrition related to surgery.
3. Altered comfort related to surgical process.
Nursing intervention:
1. A nasogastric tube is put in the upper esophageal segment and is
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aspirated frequently, to prevent collection and aspiration of secretion
into the trachea.
2. Intravenous fluids are administered to maintain the hydration status of
infant.
3. Place the infant in semi-upright position and administer oxygen if
cyanosis is present.
4. A cervical esophagostomy is made to drain out secretions from blind
esophageal pouch and administer oxygen to infant.
5. Feed the infant orally or by gastrostomy.
6. Position the baby comfortably in semi-fowler’s position and administer
analgesics.
Complication:
 Tracheomalacia (weakness of tracheal wall)
 Anastomotic leak (tension)
 Strictures (narrowing, esophageal dilation)
 Dysphagia (esophageal motility disorder)
 Respiratory distress
 Gastro-esophageal reflux.
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