Percutaneous dilational tracheostomy

Drape with sterile towels

 

 

 

Infiltrate skin, subcutaneous tissue and muscle with lidocaine and adrenaline

 

 

 

Check the tracheostomy kit and the tracheostomy tube. Work out which dilator fits the tracheostomy tube. Fill the syringe with 2-3 ml of saline or sterile water.

 

 

Make a horizontal incision approximately 1.5 cm long below the level of the cricoid cartilage (the original Ciaglia technique used a vertical incision)

 

 

Using artery forceps blunt dissect down to trachea.

 

 

 

Use a finger to widen the track and to palpate the tracheal rings. The tracheostomy should be placed between the first and second tracheal rings. Ask the anaesthetist to pull back the endotracheal tube.

 

 

Attach the cannula to the syringe and place the tip of the cannula on the trachea. If you are using a bronchoscope insert it at this point. Do not insert it beyond the tip of the endotracheal tube. Advance the cannula until you aspirate air from the trachea then advance the plastic cannula over the needle into the trachea

 

Confirm that the cannula is still in the trachea after the needle has been removed by aspirating air.

 

 

 

Insert the guidewire through the cannula and then remove the cannula. Thread the punch over the guidewire into the trachea.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Photos © Charles Gomersall 2000