Tracheostomy

Details of Procedure:

DVT prophylaxis has been ordered within 24hrs of surgery

Second generation cephalosporin / therapeutic antibiotics were started prior to incision.

The patient was correctly identified, brought to the operating room, and transferred to the operating table. General anesthesia was administered. The patient was positioned with a shoulder roll in neck extension. Her neck was prepped and draped in a sterile fashion. I began with a transverse incision 2 finger breadths above the sternal notch, just below the cricoid cartilage. The incision was carried down through subcutaneous tissue and platysma. The dissection then continued through the mid-line between the strap muscles. The thyroid gland was visualized and the pre-tracheal fascia was incised to reveal the trachea. Hemostasis was obtained at this point.

A point on the trachea between the 2nd/3rd tracheal rings was identified for tracheostomy and this was marked with cautery. In conjunction with anesthesia, the ETT cuff was deflated and advanced into the trachea. I then entered the trachea with a #15 blade, making a inferiorly based trap-door incision. A 3-0 PDS was passed through the sternal skin and the trap door to aid with opening. Anesthesia then pulled the ETT back and I inserted a cuffed Shiley #8 tracheostomy tube after trach spreader dilation. The anesthesia circuit was connected to the tracheostomy and end tidal co2 confirmed. The trach was secured to the skin with 2-0 nylon suture. Betadine soaked gauze was used as dressing below the tracheostomy.