Anesthetize the skin at the planned tracheotomy site with mepivacaine 1% and 1:100,000 epinephrine (about 5 ml).
The skin will become ischemic and turn white; this will lessen any bleeding.
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Local anesthesia of the surgical field
![Local anesthesia of the surgical field]()
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Bronchoscopic overview
![Bronchoscopic overview]()
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Remark: Since this is a text-to-speech computer voice, it may mispronounce some medical terminology.Tracheal assessment Pull back the ventilation tube to the level of the vocal cords.
Transilluminate the site of the planned puncture from the lumen of the trachea with the light of the bronchoscope.
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Tracheal puncture and introduction of the Seldinger guidewire
![Tracheal puncture and introduction of the Seldinger guidewire]()
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Remark: Since this is a text-to-speech computer voice, it may mispronounce some medical terminology.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.
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Skin incision and insertion of the dilator
![Skin incision and insertion of the dilator]()
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Remark: Since this is a text-to-speech computer voice, it may mispronounce some medical terminology.Gain access through a horizontal skin incision of about 1.5 cm through which the tracheotomy tube will be introduced later.
Do not leave any skin bridges near the Seldinger guidewire.
Now gently screw down the plastic dilator over the guidewire until it stops and then remove it immediately.
Dilating the pretracheal tissue
Insert special dilating forceps over the guidewire and sufficiently dilate the pretracheal tissue.
Insert special dilating forceps over the guidewire and sufficiently dilate the pretracheal tissue.
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