TRACHEOTOMY ± Operative procedure that

creates an artificial opening in the trachea.

TRACHEOSTOMY ± Converting this opening to
a permanent or semi permanent stoma on the
skin surface.

The first correct description of the tracheotomy operation

-- Ibn Zuhr in the 12th century.
The currently used surgical Tracheostomy technique
-Dr. Chevalier Jackson from Pittsburgh, Pennsylvania.
1. Emergency ± Urgent establishment of Airway

2. Elective
i. Therapeutic
r Respiratory obstruction
r Tracheobronchial Secretions
r Assisted Ventilation
ii. Prophylactic
r Anticipated obstruction or aspiration

3. Permanent
r Bilateral Abductor paralysis
r Laryngeal Stenosis
Other types :

1) High Tracheostomy ±
r Above thyroid isthmus
r Perichondritis & Subglottic Stenosis

2) Mid Tracheostomy
r Most preferred

3) Low Tracheostomy
r Below level of isthmus
r Large blood vessels
r Deep seated trachea
r Tube impinges on Suprasternal notch
r henever possible ± Endotracheal intubation.

r Position ± Supine with neck extended

to bring trachea forward.

rAnesthesia ± 1-2  Lignocaine with Epinephrine

Not needed in Emergency & Unconscious
patients.
 r
ransverse incision 5cm long, finger
breadth above sternal notch.
1. Vertical skin incision along
relaxed skin tension lines 1 cm below the cricoid
two finger breadths above the sternal notch.
2. Retractors are placed, the Dilated veins are ligated.
skin & tissues are
dissected in the midline.
3. The strap muscles are visualized in the midline & the
muscles are divided along the raphe, then retracted
laterally
G. The thyroid isthmus lies in the field of the dissection.
Typically, the isthmus is to 10 mm in its vertical dimension,
mobilize it away from the trachea and retract it or divide the
thyroid isthmus between the ligatures.
. Few drops of G Lignocaine injected.
 An inferior based flap, or
Björk flap, (through 2nd & 3rd
Tracheal rings) is commonly
used.

£. Then place the tracheal incision in the second or third

tracheal interspace. A vertical incision is converted to circular
opening.
è. The windpipe and
surrounding area is completely
suctioned of all secretions and
blood.

8. Insert Tracheostomy tube (with

concomitant withdrawal of
endotracheal tube), secure with tape
around neck.
. Gauze dressing
 Guide wire and catheter are
Guide wire introduction, with advanced together into the trachea
removal of sheath as far as the skin positioning marks
on the guide catheter to the skin.
Guide wire, guide catheter,
and dilator unit are advanced
together into the trachea to
the skin positioning mark
The tracheotomy tube is loaded onto a
dilator and advanced into the trachea over
the guide wire and catheter. The guide wire
and catheter are removed, leaving only the
tracheostomy tube in the trachea
1.Ciaglia - the
sequential insertion and
removal of a series
(usually G- ) of
increasing larger
dilators over the wire
into the trachea.

2.Griggs - insertion of
a specially designed
pair of guide-wire
forceps along the wire
into the trachea and
then are opened to
complete the dilation
in one step.
3.Rhino - insertion of a
single large tapered
dilator over a plastic
guidewire
reinforcement.

G.Frova Percutwist -
insertion of a specially
designed screw of
increasing diameter
which rotates to create
the dilatation.
METAL TRACHEOSTOMY
TUBES

1. Fullers Tracheostomy tube

2. Jacksons Tracheostomy
tube
 NON - METALLLIC
TRACHEOSTOMY TUBES

1. Cuffed Tracheostomy Tube

2. Cuffless Tracheostomy Tube

 Neonatal Tracheostomy Tubes ( Portex &
Silastic )

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