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Percutaneous dilatational tracheotomy - general and visceral surgery
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Local anesthesia of the surgical field
Tracheal puncture and introduction of the Seldinger guidewire
Puncture in a strictly median and slightly caudad direction.
Concurrent bronchoscopic monitoring helps prevent puncture of the posterior tracheal wall or the cuff of the endotracheal tube and verify the correct position of the puncturing needle.
When air is aspirated into the syringe, the needle is within the tracheal lumen.
Skin incision and insertion of the dilator
Dilating the pretracheal tissue
Dilating the trachea under bronchoscopic monitoring
Inserting and fixating the tracheotomy tube
Bronchoscopic verification of tube position
As final step bronchoscopically verify the tube position, rule out tracheal injury and suction any blood and secretions.
Note: While the cuff is deflated, the bronchoscope may be advanced through the larynx along the outside of the tracheotomy tube until it reaches the tracheal bifurcation; during retraction, the entire length of the posterior membranous wall can be inspected.