Percutaneous Tracheostomy

The patient was correctly identified and brought to the operating room. She was given 1st generation cephalosporin prophylactic antibiotics. She is on DVT prophylaxis.

The patient was positioned supine with shoulder roll in place. The neck was extended. We began with bronchoscopy and there was copious mucus in the trachea. This was suctioned clear.

I made a 2cm transverse incision 2cm above the sternal notch. I then dissected bluntly down to trachea using hemostat. Under bronchoscopic guidance, the ETT was retracted and I placed a large needle into the trachea at 12:00. I then placed the wire through the needle. The tract was then dilated serially using the Portex Trach system.

I then inserted a #8 Portex trach into the dilated tract.

The position was confirmed with bronchoscopy through the trach. The trach was sutured in place with 2-0 prolene sutures and a betadine 4x4 was placed under the trach.

CXR is ordered.

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