A tracheostomy is a surgical procedure that creates an opening in the trachea to allow direct access to the breathing tube. It is done under general anesthesia with the head extended straight. The incision can be transverse or vertical, depending on whether it is an elective or emergency case. Indications include airway obstruction, impaired breathing function, or assisting with ventilation weaning. Complications can include bleeding, infection, tube issues, or long term stenosis or fistula formation. Decannulation considers when ventilation/suction is no longer needed and the patient can control their airway without risk of aspiration.

1. Tracheostomy

2. Trachea anatomy:
Cylindrical structure but is flattened posteriorly
Measures about 11 cm in length
Starts from the inferior part of the larynx(cricoid
cartilage) in the neck, opposite the C6 vertebra,
to the inter-vertebral disc between T4-T5
vertebrae in the thorax
In cross-section, it is D-shaped, with incomplete
cartilaginous rings anteriorly and laterally, and a
straight membranous wall posteriorly
(chondromembranous)

5. Definition:
It is a surgical procedure to
open a direct airway through
an incision in the trachea.

6. Procedure:
The operation should be carried out under
general anesthesia and endotracheal
intubation.
The neck should be extended, the head should
be straight (not turned to one side).
Transverse incision is preferable to vertical
incision.

7. incision
Transverse
Elective
procedures
Vertical
Emergency
Pediatrics

8.  The incision should be centered midway
between the cricoid cartilage and sternal notch .
The strap muscles are identified and retracted
laterally and the thyroid isthmus is divided.
 The cricoid must be identified by palpation and
the tracheal rings counted.
An opening is made into the trachea and stitch is
made in place.

10. Indications:
 Obstruction of the upper airway like foreign body,
trauma, infection, laryngeal tumors and facial
fractures.
 Impaired respiratory function (head trauma lead to
unconsciousness, bulbar poliomyelitis).
 To assist weaning from ventilation support in patient
in the ICU.
 To help clear secretions in the upper airway.
 Prophylaxis (as in preparation for extensive head and
neck procedures and the convalescent period)

11. Complications:
Immediate complications:
Hemorrhage.
Apnea.
Trauma to recurrent laryngeal nerve and
great vessels.
Damage to esophagus.
Pneumothorax.
Subcutaneous emphysema.

12. Early complications:
The critical period is the first 48 hrs.
Tube obstruction or displacement.
Bleeding from tracheostomy site.
Infection (Tracheitis, Cellulites).
Aspiration.
Plugging with mucus .
Subcutaneous emphysema .
Atelectasis.

13. Late complicatios:
Tracheal stenosis.
Fistula formation (tracheo-cutaneous or
trachea-esophagus or trachea-innominate).
Airway obstruction with aspiration.
Bleeding.
Scarring.
Tracheomalacia.

14. Decannulation:
When ventilation or suctioning no longer
needed
Patient can control their own airway
Not be at risk for aspiration.

15. This can be expected when patient
has :
Good cough.
Good ABGs (relative, for the patient).
Clear lungs.
No pathogens in sputum.

16. Contraindications:
A strong relative contraindication to discrete
surgical access to the airway is the
anticipation that the blockage is a laryngeal
carcinoma.
No absolute contraindications

17. Tracheostomy speaking valve: