This document summarizes the tracheostomy procedure. It is performed to provide a more secure airway for patients who require prolonged intubation or have upper airway obstruction or neurological disorders requiring a secure airway. The procedure involves making an incision through the neck and trachea to insert a tracheostomy tube. Potential complications include bleeding, infection, tube dislodgement, and injury to nearby structures like the esophagus or recurrent laryngeal nerve. The tube is later downsized or removed once the original indication is resolved and the patient can tolerate capping of the tracheostomy site.

1. Tracheostomy
Dr. John McCormick-Deaton, DO
General Surgery
PGY-2

2. Purpose/Description
• Elective procedure
• Provides a more secure airway
• Improves Pt comfort
• Improves Oral Hygiene
• Increases Pt mobility
• Enhances secretion removal

3. Indications
• Prolonged intubation
• Need for secure airway in Maxillofacial injury
• Upper Airway obstruction
• Need for secure airway in Neurological
disorders

4. Complications
• Bleeding
• Wound Infection
• Tube dislodgement/malposition
• Pneumothorax, pneumomediastinum, SubQ emphysema
• Esophageal perforation
• Tracheal malacia
• Tracheal Stenosis
• Fistulas: tracheoesophageal, tracheoinnominate artery
(TIAF)
– Occurs Rarely (~0.3%)
– 50-80% mortality rate
• RLN Injury

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.

7. Landmarks

8. Anatomy

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

14. Procedure
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