Overview

Tracheostomy is a surgical procedure to create an opening in the trachea for airway access, commonly performed for long-term ventilation or airway obstruction.

Tracheostomy is crucial for managing airway obstruction, long-term ventilation, and providing secure airway access in critically ill patients.

Learn more in our comprehensive RxDx ENT Course

Indications

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Airway Obstruction

Upper airway obstruction

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Long-term Ventilation

Prolonged intubation

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Neurological Conditions

Impaired airway protection

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Head and Neck Cancer

Airway compromise

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Emergency Airway

Failed intubation

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Uncontrolled bleeding

Relative Contraindications

✗ Recent surgery
✗ Infection at site
✗ Severe coagulopathy

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient assessment, equipment setup, positioning, and understanding contraindications.

Step-by-Step Procedure

Step 1: Patient Preparation

Position patient, administer anesthesia.

⚠️ Common Mistakes to Avoid:

  • Poor positioning
  • Inadequate anesthesia

💡 Pro Tip:

Use proper positioning.

Step 2: Incision

Make horizontal incision at appropriate level.

⚠️ Common Mistakes to Avoid:

  • Wrong level
  • Inadequate incision

💡 Pro Tip:

Use proper technique.

Step 3: Tissue Dissection

Dissect through subcutaneous tissue and strap muscles.

⚠️ Common Mistakes to Avoid:

  • Inadequate exposure
  • Bleeding

💡 Pro Tip:

Use careful technique.

Step 4: Tracheal Exposure

Expose trachea and identify appropriate interspace.

⚠️ Common Mistakes to Avoid:

  • Wrong interspace
  • Poor exposure

💡 Pro Tip:

Identify landmarks.

Step 5: Tracheal Incision

Make incision in trachea and insert tube.

⚠️ Common Mistakes to Avoid:

  • Wrong incision
  • Tube malposition

💡 Pro Tip:

Use proper technique.

Step 6: Tube Securing

Secure tube and close incision.

⚠️ Common Mistakes to Avoid:

  • Poor securing
  • Inadequate closure

💡 Pro Tip:

Ensure proper securing.

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Post-procedure Care

Post-procedure care involves tube care, monitoring for complications, and long-term management.

Complications & Management

Complication Incidence Signs Management Prevention
Bleeding 2-5% Active bleeding, hematoma Return to OR, cautery Proper hemostasis
Infection 1-3% Wound infection, cellulitis Antibiotics Sterile technique
Tube displacement 1-2% Respiratory distress Tube replacement Proper securing
Tracheal stenosis 1-2% Stridor, dyspnea Dilation, surgery Proper technique

Clinical Pearls

💡

Identify key landmarks.

🎯

Use appropriate tube size.

⚡

Ensure proper tube placement.

🔍

Check tube position.

📊

Document procedure details.

🎨

Provide clear post-op instructions.

⚠️

Monitor for complications.