--- title: "Tracheostomy - Procedure, Steps & Postoperative care" description: "ENT notes on Tracheostomy - Procedure, Steps & Postoperative care." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/tracheostomy-procedure-steps-postoperative-care" categories: ["Surgery", "Larynx and Trachea"] video: "https://www.youtube.com/watch?v=9T9qiYnd4ZY" image: "https://media.theentresident.com/og-images/tracheostomy-procedure-steps-postoperative-care.png" --- # Tracheostomy - Procedure, Steps & Postoperative care ENT notes on Tracheostomy - Procedure, Steps & Postoperative care. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=9T9qiYnd4ZY ## 🫁 Tracheostomy – Surgical Steps & Post-operative Care This post covers: - Pre-operative preparation - Surgical steps of tracheostomy - Confirmation of Tracheostomy tube placement - Immediate securing of tube - Post operative care of Tracheostomy tube - Tracheostomy tube suctioning protocol - Tracheostomy tube care - Tracheostomy tube change & stoma care --- ### 📝 Pre-operative Preparation #### ✅ Informed Consent - Explain procedure - Possible complications - Recovery expectations - Long-term care requirements #### ✅ Equipment Check - Correct size **tracheostomy tube** - Check cuff integrity (inflate → look for air leak) - Lubricate tube tip with **lignocaine jelly** - Keep ties ready - Ensure **suction apparatus is functioning** --- ### 🛌 Tracheostomy Position of Patient - Patient placed **supine** - Neck **extended** - Sandbag/pillow under shoulders - Head supported on **head ring** --- ### 💉 Anaesthesia - Local or General anaesthesia > What local anesthesia is used in Tracheostomy? > Why should you avoid Adrenaline in Tracheostomy? --- ### ✂️ Tracheostomy Incision #### 📍 Tracheostomy Incision Site - Midway between **cricoid cartilage and suprasternal notch** - OR **2 finger breadth above suprasternal notch** #### 📍 Tracheostomy Incision Types - Horizontal Incision (Elective) - Vertical Incision (Emergency) > What are the advantages and disadvantages of Horizontal incision for Tracheostomy? > What are the advantages and disadvantages of Vertical incision for Tracheostomy? --- ### 🔍 Tracheostomy Procedure Steps Following are the steps of Tracheostomy : 1️⃣ **Tracheostomy Skin incision** 2️⃣ **Deepening the Incision** > What are the layers encountered while deepening the skin incision in Tracheostomy? > Which vein can get injured while deepening the skin incision in Tracheostomy? 3️⃣ **Strap Muscle Separation** - Separate in midline: - Sternohyoid - Sternothyroid 4️⃣ **Thyroid Isthmus Management** Two options: - Retract superiorly/inferiorly - Clamp → divide → ligate 5️⃣ **Identification of Trachea** > What are the different features that will help in correct identification of trachea during tracheostomy? > What test is done to confirm the trachea position? 6️⃣ **Tracheal Incision** Before Tracheal incision, we should check for the following :- - Achieve **complete haemostasis** - Recheck suction apparatus - Instill **few drops of 4% lignocaine** into trachea > Why do we instill a few drops of 4% lignocaine into the trachea before the tracheal incision? > What is the most common site of Tracheal Incision? > What are the different types of Tracheal Incisions? > What is Bjork Flap? > What are the disadvantages of Bjork Flap? 👉 Children → Prefer **Vertical tracheal incision** ⚠️ Avoid round opening → Risk of **tracheal stenosis** 🔄 **Variations in Trachea** - Soft trachea → Children → Need stay sutures - Hard calcified trachea → Elderly → May need bone cutter - Carcinoma larynx → High tracheostomy 🚨 **Special Points in Emergency Tracheostomy** - Perform rapidly → Anoxia >5 min fatal - Avoid intratracheal anaesthetic - Avoid paratracheal infiltration → RLN paralysis risk 7️⃣ **Tube Insertion** - Insert **tracheal dilator** - Insert tube with **obturator** - Remove obturator immediately > What is the most common Tracheostomy tube size used in males and females? > How would you confirm the placement of the Tracheostomy tube into the trachea? > What are the causes of Respiratory Failure After Tracheostomy Tube Placement? 8️⃣ **Securing the Tube** - Inflate cuff with **3-5 ml air** - Cuff lodges between **4th-7th tracheal rings** - Release neck extension - Tie tapes → One finger space - Keyhole dressing around stoma --- ### 🏥 Post operative Care of Tracheostomy 1️⃣ **Communication** - Patient cannot speak - Provide **paper + pen** - Provide **bell** 2️⃣ **Humidification (Very Important)** Loss of nasal humidification → crust formation **Methods:** - Wet gauze over tube - Heat Moisture Exchanger (HME) - Nebulization - Boiling kettle (last option) 3️⃣ **Tracheostomy tube suction** **Frequency** - Every **30 min in first 24 hrs** - Then every **1–2 hrs** > What is the formula for selectig the catheter size for tracheostomy tube suctioning? **How to suction tracheostomy tube** - Deflate cuff - Attach catheter to a source of negative pressure: **100–150 mmHg** - Lubricate catheter tip - Insert catheter while blocking the suction during inspiration - Suction while withdrawing in rotating motion > What is the pressure used usually to suction the tracheostomy tube? ⚠️ **Duration:** - 5–10 seconds only - Maximum 2–3 attempts > What should you do if the secretions in the tracheostomy tube is too thick? 4️⃣ **Tracheostomy Tube Care & Tracheostomy Tube Change** - Do **NOT** change outer tube for **5–7 days** - Inner tube cleaning: - 3–4 times/day initially - Clean with **Hydrogen peroxide** - Wash → Dry → Reinsert - After 7 days → Can change to **uncuffed tube** 5️⃣ **Tracheostomy Stoma Care** - Daily dressing change - Prevent crust & granulation - Look for infection - Apply antibiotic ointment if needed 6️⃣ **Tracheostomy tube cuff care** - Deflate **every 1 hour for 5 minutes** - Prevent **tracheal stenosis** 7️⃣ **Nutrition** - Encourage oral feeding - If not possible → Parenteral nutrition 8️⃣ **Oral Hygiene** - Maintain regular oral care --- ### ⭐ Exam Pearls - Most common tracheostomy → **Mid tracheostomy** - Tube change only after **5–7 days** - Suction catheter size formula → **Very important viva** - Cuff must be periodically deflated → Prevent stenosis --- ➡️ Next Topic: **Complications of Tracheostomy** --- ## About This Note This free ENT note on Tracheostomy - Procedure, Steps & Postoperative care was written by Dr. Mausumi Das and is paired with a corresponding video lecture. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/tracheostomy-procedure-steps-postoperative-care When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## Related Notes by Category - Surgery: https://www.theentresident.com/ent-notes-lectures/category/surgery.md - Larynx and Trachea: https://www.theentresident.com/ent-notes-lectures/category/larynx-and-trachea.md ## About The ENT Resident The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students. Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself. Browse all ENT notes and lectures on The ENT Resident: https://www.theentresident.com/ent-notes-lectures.md ## Medical-use Boundary The ENT Resident provides educational material for medical learning and revision. 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