Percutaneous Tracheostomy Procedure Note [.phrase]
Procedure Note: Percutaneous Tracheostomy
Operator: Castaneda
A time out was performed to confirm correct patient, procedure, and equipment.
After obtaining informed consent, the patient was placed in the supine position with the neck gently extended by using a shoulder roll. Anatomic landmarks were confirmed by palpation of the thyroid and cricoid cartilages and trachea. The patient was placed on a ventilator rate and 100% oxygen. The surgical area was ultrasounded and there were not aberrant blood vessels or a high riding aorta in the immediate vicinity of the planned incision site (picture below)
The anterior neck was prepped with chlorhexidine and draped in the usual sterile fashion. The bronchoscope was passed into the ET tube to allow for direct visualization. The 1st 2nd and 3rd tracheal rings were re-palpated and marked with a surgical marker.
A 2 cm vertical incision was made over the upper trachea with a 15-blade scalpel. The subcutaneous tissue was bluntly dissected with a hemostat at the midline to the pretracheal fascia. The needle was advanced into the trachea under direct vision via the bronchoscope (picture below). The guidewire was inserted with endoscopic visualization and advanced into the trachea beyond the carina. The needle was withdrawn over the guidewire.
The entry site was sequentially dilated with a pre-hydrated Rhino dilator. A pre-loaded size 6.0 cuffed tracheostomy tube and introducer was advanced over the guidewire and the tracheostomy tube balloon was inflated. The guidewire and introducer were removed, and the inner cannula was placed. The ventilator connection was transferred from the endotracheal tube to the tracheostomy tube and accurate placement of the tracheostomy tube and hemostatsis of the tracheal entry site confirmed endoscopically through tracheostomy tube. The endotracheal tube was removed. The tracheostomy tube was secured with 2-0 silk sutures x4 and a velcro band.
Please see separate Bronchoscopy note
- CXR ordered and reviewed. Confirmed position and no pneumothoraces/pneumomediastinum
- Will return to remove sutures in 10 days
- First Trach Exchange 7-14 Days
- If Tracheostomy tube dislodges in this acute period, please re-intubate endotracheally.
Christian Castaneda, MD
Pulmonary and Critical Care Medicine