--- title: "Tracheostomy Instruments" description: "ENT notes on Tracheostomy Instruments - Identification, Uses, Advantages & Disadvantages." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/tracheostomy-instruments" categories: ["Instruments in ENT"] video: "https://www.youtube.com/watch?v=XzruKZr9hRA" image: "https://media.theentresident.com/og-images/tracheostomy-instruments.png" --- # Tracheostomy Instruments ENT notes on Tracheostomy Instruments - Identification, Uses, Advantages & Disadvantages. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=XzruKZr9hRA ## 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 | Patient | Tube Size | | --- | --- | | Adult Male | 8–8.5 mm | | Adult Female | 7.5–8 mm | --- ### 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 | Instrument | Primary Use | | --- | --- | | Langenbeck Retractor | Soft tissue retraction | | Blunt Tracheal Hook | Retract thyroid isthmus | | Sharp Tracheal Hook | Fix trachea/cricoid | | Double Hook Retractor | Retract muscles and fascia | | Trousseau Tracheal Dilator | Dilate tracheal opening | | Chevalier Jackson Tube | Long-term metallic tracheostomy | | Fuller's Tube | Self-dilating metallic tube | | Portex Tube | Modern cuffed tracheostomy tube | | BP Handle No.11 | Skin incision | | Artery Forceps | Dissection and hemostasis | | Skin Hook | Retract skin | | Allis Forceps | Tissue holding | | Needle Holder | Suturing | | Lignocaine Jelly | Tube lubrication | --- ### 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. --- ## About This Note This free ENT note on Tracheostomy Instruments was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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