Tracheostomy Instruments

Instruments Used in Tracheostomy

In this post, we'll discuss the important instruments used during tracheostomy, focusing on:

• Identification
• Parts of the instrument
• Uses
• Advantages
• Disadvantages
• Viva questions

1️⃣ Langenbeck Retractor

Identification

• Hand-held retractor

• Consists of:

  • Handle
  • Blunt retractor blade

Uses

• Retracts skin
• Retracts superficial fascia
• Retracts strap muscles
• Exposes deeper neck structures during tracheostomy

Usually two retractors are used simultaneously.

Advantages

• Atraumatic blunt blade
• Easy to handle
• Lightweight
• Available in multiple sizes

Disadvantages

• Not self retaining
• Requires an assistant
• Not suitable for deep cavity retraction

Why is Langenbeck Retractor considered atraumatic?

Why are two retractors usually required during tracheostomy?

2️⃣ Blunt Tracheal Hook

Identification

• Hook-shaped instrument
• Blunt tip

Uses

Primary Use

• Retracts thyroid isthmus superiorly during tracheostomy

Other Uses

• Retraction of strap muscles
• Exposure of tracheal rings

What is the usual site for performing tracheostomy?

Why is the thyroid isthmus retracted during tracheostomy?

3️⃣ Sharp Tracheal Hook

Identification

• Hook-shaped instrument
• Sharp pointed tip

What is the other name for Sharp Tracheal Hook?

Uses

• Fixation of trachea during tracheostomy
• Stabilizes the airway before tracheal incision

Through which structure is the Sharp Tracheal Hook passed? Why?

4️⃣ Double Hook Retractor

Identification

• Retractor with two blunt hooks

Uses

• Retracts skin
• Retracts subcutaneous tissue
• Retracts strap muscles
• Retracts pretracheal fascia

Provides better exposure of the surgical field.

Why is it called the Double Hook Retractor?

5️⃣ Trousseau Tracheal Dilator

Identification

• Double-bladed dilator
• Blunt tips
• No catch mechanism
• No serrations

Uses

• Dilates tracheal opening after tracheal incision
• Tracheostomy tube changes

What are the advantages & disadvantages of Trousseau Tracheal Dilator?

Describe how Trousseau Tracheal Dilator is used during tracheostomy.

Why does Trousseau Dilator reduce false passage formation?

6️⃣ Chevalier Jackson Metallic Tracheostomy Tube

Identification

• Metallic tracheostomy tube
• Made of German Silver

What is German Silver?

Parts

• Outer tube
• Inner tube
• Obturator
• Neck flanges
• Locking mechanism

Functions of Parts

Outer Tube

• Remains inside tracheostomy stoma

Inner Tube

• Slightly longer than outer tube
• Collects secretions
• Can be removed and cleaned

Obturator

• Blunt tipped introducer
• Facilitates atraumatic insertion

Neck Flanges

• Secure tube around neck

Lock

• Prevents displacement of inner tube

What are the advantages & disadvantages of Chevalier Jackson Metallic Tracheostomy Tube?

Why is the inner tube longer than the outer tube?

What is the function of the obturator?

7️⃣ Fuller's Bivalved Metallic Tracheostomy Tube

Identification

• Metallic tracheostomy tube
• Bivalved outer tube
• Inner tube with fenestration

Parts

Outer Tube

• Bivalved design
• Acts as self-dilator during insertion

Inner Tube

• Longer than outer tube
• Contains fenestration

Advantages

Bivalved Design

• No separate tracheal dilator required

Fenestration

• Allows airflow through larynx
• Facilitates phonation
• Helps early decannulation

What are the advantages & disadvantages of Fuller's Bivalved Metallic Tracheostomy Tube?

Why does Fuller's tube not require a separate tracheal dilator?

What is the purpose of fenestration in the inner tube?

What are the advantages & disadvantages of Metallic Tracheostomy Tubes?

8️⃣ Portex Tracheostomy Tube

Identification

• Made of PVC
• Contains blue radiopaque line
• May be cuffed or uncuffed

Parts

• Single tube
• Neck flanges
• Obturator
• Cuff
• Pilot balloon

Radiopaque Line

Contains Barium salts

Purpose:

• Visible on X-ray
• Helps locate tube position

Cuff Characteristics

• High-volume
• Low-pressure cuff

What are the advantages of High Volume Low Pressure Cuff in Portex Tracheostomy tube?

Cuff Inflation

Usually 5–10 mL air

What is the recommended Cuff Pressure in Portex Tracheostomy tube?

What are the advantages & disadvantages of Cuffed Tracheostomy Tube?

What are the advantages & disadvantages of Portex Tracheostomy Tube?

Why is the blue radiopaque line incorporated into Portex tubes?

What complications occur due to prolonged cuff inflation?

📏 Portex Tube Size Formula

Children Below 6 Years

Internal Diameter (mm) = Age ÷ 3 + 3.5

Example:

Age = 6 years

Diameter = 6 ÷ 3 + 3.5

= 5.5 mm

Children Above 6 Years

Internal Diameter (mm) = Age ÷ 4 + 4.5

Example:

Age = 8 years

Diameter = 8 ÷ 4 + 4.5

= 6.5 mm

Adults

9️⃣ Other Instruments Used During Tracheostomy

BP Handle with No. 11 Blade

• Skin incision
• Sharp pointed blade

Straight & Curved Artery Forceps

• Tissue dissection
• Hemostasis

Skin Hook

• Retracts skin edges

Allis Tissue Forceps

• Tissue holding during dissection

Needle Holder

• Skin suturing
• Stay sutures

Lignocaine Jelly

• Lubricates tracheostomy tube
• Facilitates atraumatic insertion

Plain Forceps

• Tissue handling during suturing

Toothed Dissecting Forceps

• Skin suturing

Tracheostomy Instruments Summary Table

Viva Pearls

• Most tracheostomies are performed through the 2nd and 3rd tracheal rings.
• Thyroid isthmus often requires superior retraction.
• Trousseau Tracheal Dilator is used to dilate the tracheal opening.
• Chevalier Jackson tube is made of German silver.
• Fuller's tube acts as its own tracheal dilator.
• Fenestrated tubes facilitate phonation.
• Portex tubes are MRI compatible.
• High-volume low-pressure cuffs reduce tracheal injury.
• Prolonged cuff inflation can cause tracheal stenosis and tracheomalacia.
• Metallic tubes are preferred for long-term tracheostomy.