Outline of procedure

The following provides a brief summary of a tracheostomy procedure:

• palpate the cricoid cartilage
• make transverse incision below the cricoid cartilage at the level of the tracheal ring - this is generally two finger-breadths above the sternal notch
• separate and retract strap muscles sideways
• thyroid isthmus is retracted or divided and sutured
• control bleeding
• excise a one centimetre disc in the trachea in the 3rd or 4th ring; the first ring is not cut through as there is a greater incidence of late post-procedure stenosis
• insert a tracheostomy tube and secure by inflating balloon
• ensure ventilation is occurring - auscultate axillae
• ensure haemostasis
• suture skin loosely around the tube in two layers: deep fascia with absorbable sutures and skin with medium gauge nylon or similar non-absorbable suture
• the tube is secured by tying or taping it to the neck
• at the point of contact of tube and skin, padding should be placed to prevent rubbing. It should be replaced daily.

An alternative approach is non-surgically and percutaneously:

• local anaesthetic is infiltrated at the same site
• a stylet is inserted through to the trachea
• successively larger dilators are put over the top of the stylet until a hole large enough to pass a tracheostomy tube is attained
• the tube is placed into the trachea and secured in place by inflation of the balloon