Surgical Airway: Tracheostomy Procedure
A tracheostomy is a surgically created opening in the trachea to establish an alternative airway. This procedure is typically performed in emergency situations when endotracheal intubation is not possible or is contraindicated, or electively to provide long-term ventilatory support.
Indications
- Upper airway obstruction (e.g., foreign body, tumor, severe infection)
- Trauma to the face or neck
- Prolonged mechanical ventilation
- Neuromuscular diseases affecting respiratory muscles
- Congenital anomalies of the airway
- Severe sleep apnea
Surgical Techniques
Several techniques exist for performing a tracheostomy, including surgical (open) tracheostomy and percutaneous dilatational tracheostomy (PDT).
Surgical Tracheostomy
This method involves a surgical incision in the neck, dissection of the strap muscles, and creation of an opening in the trachea. The specific steps may vary depending on the patient's anatomy and the surgeon's preference. Proper lighting, retraction, and hemostasis are essential.
Percutaneous Dilatational Tracheostomy (PDT)
PDT is typically performed at the bedside using a guidewire technique. A small incision is made in the neck, and the trachea is punctured under bronchoscopic guidance. The opening is then gradually dilated to accommodate the tracheostomy tube.
Anatomical Considerations
A thorough understanding of neck anatomy is critical for a safe and effective procedure. Key structures to identify and avoid include:
- Thyroid gland
- Carotid arteries
- Jugular veins
- Recurrent laryngeal nerves
- Esophagus
Equipment and Supplies
- Tracheostomy tube (various sizes and types)
- Scalpel
- Tracheal hook
- Dilators (for PDT)
- Guidewire (for PDT)
- Bronchoscope (for PDT)
- Suction equipment
- Local anesthetic
- Suture material
- Sterile drapes
- Surgical instruments (e.g., hemostats, retractors)
Potential Complications
Possible complications associated with this intervention include:
- Bleeding
- Infection
- Pneumothorax
- Subcutaneous emphysema
- Tracheal stenosis
- Tracheoesophageal fistula
- Injury to surrounding structures (e.g., recurrent laryngeal nerve, esophagus)
- Dislodgement or obstruction of the tracheostomy tube
Post-operative Care
Post-operative care involves ensuring proper tracheostomy tube placement, maintaining a patent airway, providing humidification, and preventing infection. Regular suctioning and cleaning of the stoma site are essential.