Overview

Tracheostomy is a surgical procedure used to create an opening in the trachea for long-term airway management and ventilation.

Tracheostomy is crucial for patients requiring prolonged mechanical ventilation, airway protection, or long-term airway access.

Learn more in our comprehensive RxDx Surgery Course

Indications

✓
Prolonged Ventilation

Long-term mechanical ventilation

✓
Airway Obstruction

Upper airway obstruction

✓
Neurological Conditions

Impaired airway protection

✓
Head and Neck Surgery

Post-operative airway management

✓
Trauma

Severe facial trauma

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Uncontrollable bleeding
✗ Severe coagulopathy

Relative Contraindications

✗ Previous neck surgery
✗ Radiation therapy
✗ Infection

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

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

Step-by-Step Procedure

Step 1: Patient Preparation

Position patient, prep neck.

⚠️ Common Mistakes to Avoid:

  • Poor positioning
  • Inadequate prep

💡 Pro Tip:

Extend neck properly.

Step 2: Incision

Make horizontal incision at appropriate level.

⚠️ Common Mistakes to Avoid:

  • Wrong level
  • Poor incision

💡 Pro Tip:

Use proper landmarks.

Step 3: Dissection

Dissect through tissues to trachea.

⚠️ Common Mistakes to Avoid:

  • Poor exposure
  • Bleeding

💡 Pro Tip:

Use careful dissection.

Step 4: Tracheal Incision

Make incision in trachea.

⚠️ Common Mistakes to Avoid:

  • Wrong incision
  • Poor placement

💡 Pro Tip:

Use proper technique.

Step 5: Tube Insertion

Insert tracheostomy tube.

⚠️ Common Mistakes to Avoid:

  • Wrong size
  • Poor placement

💡 Pro Tip:

Confirm placement.

Step 6: Securing

Secure tube and close incision.

⚠️ Common Mistakes to Avoid:

  • Poor securing
  • Infection

💡 Pro Tip:

Use proper technique.

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Post-procedure Care

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

Complications & Management

Complication Incidence Signs Management Prevention
Bleeding 2-5% Active bleeding Pressure, surgery Proper technique
Infection 5-10% Erythema, purulence Antibiotics Sterile technique
Tube dislodgement 1-3% Respiratory distress Reinsertion Proper securing
Stenosis 1-2% Difficulty breathing Dilation, surgery Proper technique

Clinical Pearls

💡

Use proper landmarks for incision.

🎯

Confirm tube placement.

⚡

Secure tube properly.

🔍

Monitor for complications.

📊

Document procedure.

🎨

Use sterile technique.

⚠️

Be prepared for emergencies.