Percutaneous tracheostomy

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Anesthesia of the Surgical Site
Orienting Bronchoscopy
Puncture of the Trachea and Insertion of the Seldinger Wire
Skin Incision and Insertion of the Dilator
Spreading of the pretracheal tissue
Dilation of the Trachea under Bronchoscopic Control
Insertion and Fixation of the Tracheostomy Tube
Bronchoscopic Position Check of the Cannula

Authors

Prof. Dr. med. Christoph Diefenbach

St. Katharinen Hospital Frechen

Date

date of publication: 05.04.2009
date of update: 04.10.2023

Anesthesia of the Surgical Site

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Infiltration of the skin in the area of the planned puncture site with Scandicain 1% and Epinephrine 1:100,000 (approx. 5 ml).
The skin becomes ischemically white, thus reducing bleeding.
Orienting Bronchoscopy

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Assessment of the trachea. Withdrawal of the tube up to the level of the vocal cords.
The puncture site is marked endoluminally with the light of the bronchoscope (transillumination).
Puncture of the Trachea and Insertion of the Seldinger Wire

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The puncture is performed strictly midline, in a slightly caudal direction.
The simultaneous bronchoscopic control serves to avoid puncture of the posterior tracheal wall or the tube cuff and to verify the correct position of the puncture needle.
The aspiration of air indicates the position within the trachea.
Skin Incision and Insertion of the Dilator

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A superficial approximately 1.5 cm long horizontal skin incision is made, through which the tracheostomy tube will be inserted later.
No skin bridge should remain in the area of the Seldinger wire.
Next, the plastic dilator is inserted over the wire with a rotating motion and gentle pressure up to the stop and immediately removed again.