Atos Medical PROVOX Vega Bedienungsanleitung Seite 15

coughing may remove the foreign body. Partial airway obstruction
or complete airway obstruction requires immediate intervention for
removal of the object.
Ingestion of the prosthesis – Accidental ingestion of the voice prosthesis,
or other components of the voice rehabilitation system, may occur. As
with any other foreign body, the symptoms caused by ingestion of the
prosthesis or component of the voice rehabilitation system depends
largely on size, location, degree of obstruction (if any) and the length
of time it has been present. Ingested components that have remained in
the lower esophagus may be removed by esophaguscopy or observed
for a short period of time. The object may pass spontaneously into
the stomach; foreign bodies that pass into the stomach usually pass
through the intestinal tract. Surgical removal of foreign bodies in the
intestinal tract must be considered when bowel obstruction occurs,
bleeding is present, perforation occurs or the object fails to pass
through the intestinal tract.
Hemorrhage/Bleeding of the puncture – Slight bleeding from the edges
of the TE-puncture may occur during replacement of the prosthesis and
generally resolves spontaneously. Patients on anti-coagulant therapy,
however, should be carefully evaluated for the risk of hemorrhage
prior to placement or replacement of the prosthesis.
Infection and/or edema of the TE-puncture – Infection, granulation
formation and/or edema of the puncture (e.g during radio therapy)
may increase the length of the puncture tract. This may cause the
prosthesis to be drawn inward and under the tracheal or esophageal
mucosa. Or, inflammation or overgrowth of the esophageal mucosa
may cause the prosthesis to protrude from the puncture. Temporary
replacement of the prosthesis by a prosthesis with a longer shaft is then
advisable. Treatment with broad-spectrum antibiotics with or without
corticosteroids may be considered for treatment of the infection. If
the infection does not resolve with antibiotics and/or corticosteroid
intervention in the presence of the
prosthesis, the prosthesis should be removed. In some cases stenting
the puncture with a catheter might be considered. If the puncture closes
spontaneously secondary to removal of the prosthesis, repuncture for
insertion of a new prosthesis may be required.
Granulation around the puncture – Formation of granulation tissue
around the TE-puncture has been reported at an incidence of 5%.
Electrical, chemical, or laser cauterization of the area of granulation
may be considered.
Hypertrophic scarring around the puncture – Bulging of the tracheal
mucosa over the tracheal flange may occur if the prosthesis is relatively
short. This excess tissue may be removed by using a laser (CO2, or
NdYAG). Alternatively, a prosthesis with a longer shaft can be used.
Protrusion/extrusion of the prosthesis– Protrusion of the prosthesis
and subsequent spontaneous extrusion is sometimes observed during
infection of the TE-puncture. Removal of the prosthesis is required
to avoid dislodgement into the trachea. The puncture may close
spontaneously secondary to the removal of the prosthesis. Repuncture
may be necessary for insertion of a new prosthesis.
Leakage around the prosthesis – Transient leakage around the
prosthesis may occur and may improve spontaneously. The most common
reason is that the prosthesis is too long, which is solved by inserting
a shorter prosthesis. A prosthesis of another diameter (upsizing) can
also solve the leakage. If leakage does not improve (which it often does
spontaneously), temporary removal of the prosthesis and the insertion
of a cuffed tracheal cannula and/or nasogastric feeding tube to permit
shrinkage of the puncture may be considered. Alternatively, a purse
string suture with 3x0 absorbable material could be submucosally
applied around the TE-puncture after removal of the prosthesis. The
new prosthesis should be inserted and the suture should be tightened
gently, enclosing the puncture walls around the prosthesis. If leakage
around the prosthesis is intractable, more conservative measures, surgical
closure of the puncture and subsequent repuncture may be necessary.
Tissue damage – If the prosthesis is too short, too long, or is pushed
frequently against the esophageal wall by a tracheal cannula, stoma
button, or the patients' finger, damage of the puncture, tracheal and/
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