Tracheostomy: Let’s Have a Look at the Procedure
In this video, Mr Guri Sandhu, Consultant ENT Surgeon at Charing Cross and The Royal Brompton Hospitals, demonstrates the surgical procedure for the formation of a tracheostomy.
When watching the video pay particular attention to the communication and interaction between surgical and anaesthetic team.
Inserting a tracheostomy is a high-risk airway procedure. Good teamwork and communication, experienced staff, and meticulous planning are necessary. Most insertions are elective or semi-elective, so the patient should be fasted, and their clotting, respiratory function and physiology should be optimised beforehand.
The surgeon dissects down to the trachea and the anaesthetist manipulates the tracheal tube to facilitate passage of the tracheostomy tube. The tracheal tube is removed once correct positioning of the tracheostomy tube is confirmed by chest movement and capnography. The tracheostomy tube is then safely secured.
A tracheostomy may be considered to be especially high-risk if any of the following conditions are present:
| Anatomical | Physiological |
|---|---|
| Obesity | Deranged clotting |
| Short or fixed neck | Inadequate fasting or full stomach |
| Previous surgery or radiotherapy to the site | High oxygen or ventilatory pressure requirement |
| Large thyroid goitre | Cardiovascular instability requiring a high level of support |
| Prominent blood vessels at the site | |
| Unsecured or difficult upper airway |
After watching this video, please take a few minutes to reflect on the following: Have you ever performed or assisted at an insertion of a tracheostomy? Was is percutaneous or surgical? What are the main differences? What are the Human Factors and Ergonomics implications during the procedure? Please share your thoughts in the discussion below.
In the next video, we will see Dr Helen Drewery and the Trachy Team at The Royal London Hospital, talking about multidisciplinary tracheostomy care.
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