Tracheostomy

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Introduction

A tracheostomy is a surgical opening in the anterior wall of the trachea. There are two types of tracheostomy; a percutaneous tracheostomy and a surgical tracheostomy.

Percutaneous Tracheostomy

A percutaneous tracheostomy is generally preferred to surgical tracheostomy in intensive care patients as it can be performed on the ICU, thus eliminating the logistical problems that may occur when transferring a ventilated patient to the operating theatre. There are six different techniques that are commonly performed can be distinguished:multiple dilator tracheostomy, rotational dilation tracheostomy, and translaryngeal tracheostomy.

Balloon dilatational technique

This involves the same initial stages as the Single tapered dilatational technique, but instead of a curved dilator a pressurised balloon is used to dilate the trachea to allow passage of the tracheostomy tube.

Guide wire forceps (Griggs technique)

Following the insertion of a guide wire, dilator forceps are advanced alongside the wire and into the trachea. These forceps are then opened splitting the tracheal membrane to the desired diameter to allow insertion of the tracheostomy tube.

The Ciaglia serial dilatational technique

A cannula or needle is inserted into the trachea. The guide wire is then passed in a caudal direction before a primary dilator is passed over the wire to begin dilatation of the tract. A white plastic sheath is positioned over the wire to act as a guide for the dilators. The dilator must be inserted over the guiding catheter up to a safety ridge, this is necessary to prevent damage to the curved dilator tip and kinking of the guiding catheter. Dilators of increasing size are used and once the tract is sufficiently dilated, a tracheostomy tube loaded onto the appropriately sized dilator is passed over the guide wire and plastic sheath into the patient's trachea.

Single tapered dilatational technique

This is a modification of the Ciaglia technique and uses a single tapered dilator. The one-step dilatation is faster and is the commonest method of percutaneous tracheostomy used in the UK.

Surgical Tracheostomy

A surgical tracheostomy

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