3. Indications
• Prolonged intubation
• Need for secure airway in Maxillofacial injury
• Upper Airway obstruction
• Need for secure airway in Neurological
disorders
5. Downsize
• Large caliber, non-fenestrated, cuffed tube to
Small caliber, fenestrated uncuffed tube.
– Allows for normal speech
• Intermittent finger occlusion
• Passy-Muir valve
– Facilitates stoma closure
6. Removal
• Original indication for tracheostomy resolved
• Tolerate capping >24hrs
• If upper airway mass or tissue reconstruction
was original indication; pre-decanulation
flexible laryngoscopic exam recommended.
9. Anatomy
• ~11.8 cm Long
• 18-22 cartilaginous rings
• Blood supply
– Inferior thyroid
– Internal thoracic
– Supreme intercostal
– Bronchial arteries
• Begins ~1.5cm below the Vocal Cords
• ~50% of the trachea is cervical w/ hyperextension
10. Procedure
• Vertical or Horizontal incision made over the
2nd or 3rd tracheal rings.
– Carried through the platysmas
• Blunt dissection of Strap Muscles
• Gently retract Thyroid/Isthmus
– retracted cranially
– May need to divide
11. Procedure
• Stay sutures placed laterally to ostomy incision
site
– Can be used as traction
– Landmark if dislodgement occurs
• Midline trachea incised at 2nd and 3rd ring
– Must preserve 1st tracheal ring
– Do not puncture ETT cuff
• ETT deflated and withdrawn proximal to
ostomy site by Anesthesia
12. Procedure
• Tracheal spreader to gently enlarge ostomy
and accommodate trach
• Remove inner cannula and attach to vent to
ensure proper placement
• Remove ETT
• Close w/ simple skin sutures
• Flange is secured w/ sutures and tied around
neck
