Instructions for a tracheotomy

The tracheotomy is usually performed as a surgical procedure under general anesthesia, but can also be performed under local anesthesia. It is usually only performed when the patient cannot be ventilated by other means, as the procedure is not without danger and many complications can occur. There are two different procedures for performing a tracheotomy.

Both are performed under sterile conditions and with the patient in a supine position with hyperextension of the neck. This method is used when artificial respiration of the patient is necessary and other methods, such as ventilation by mask or intubation are not applicable. This technique is particularly suitable when permanent ventilation of the patient is not necessary.

This is the case, for example, with patients in intensive care units or with diseases of the larynx or trachea. The risk of infection is lower with this procedure. The trachea is punctured with a thin, pointed cannula between the cricoid cartilage (part of the larynx) and the first cartilage of the trachea.

A guide wire can be inserted into the trachea through the cannula. An endoscope is used to check the correct position in the trachea. If the position is correct, a dilator is advanced along the wire, which expands the adjacent tissue and creates an opening for the ventilation tube.

After the dilator is retracted, the ventilation cannula is inserted into the trachea via the wire and the guide wire can be removed. The created opening to the trachea closes again spontaneously within a few days if no cannula is inserted for ventilation because the surrounding tissue has only been expanded. During the first few days, however, the ventilation tube must not be changed, as the opening would close again within a short time.

In this case, a permanent tracheotomy is performed, which is more stable and larger than in the first procedure. However, if the breathing channel is no longer needed, it must be closed in a new operation.This method is therefore particularly suitable for patients who require permanent ventilation. First, the thyroid and cricoid cartilage of the neck is palpated and marked.

The incision transverse to the trachea is made below the thyroid cartilage and is approximately 3cm in size. In the next step, the cervical muscles and possibly the connection between the thyroid lobes (thyroid isthmus) must be separated in order to get a view of the braces of the trachea. Now the trachea is opened between the 2nd and 3rd cartilage braces. Parts of the trachea are now opened like a window wing and sutured to the skin of the neck. This creates a stable connection between the ambient air and the trachea (tracheostoma), through which a breathing tube (tracheal cannula) can now be inserted.