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Outline of procedure

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The following provides a brief summary of a tracheostomy procedure:

  • palpate the cricoid cartilage
  • make transverse incision below the cricoid cartilage at the level of the tracheal ring - this is generally two finger-breadths above the sternal notch
  • separate and retract strap muscles sideways
  • thyroid isthmus is retracted or divided and sutured
  • control bleeding
  • excise a one centimetre disc in the trachea in the 3rd or 4th ring; the first ring is not cut through as there is a greater incidence of late post-procedure stenosis
  • insert a tracheostomy tube and secure by inflating balloon
  • ensure ventilation is occurring - auscultate axillae
  • ensure haemostasis
  • suture skin loosely around the tube in two layers: deep fascia with absorbable sutures and skin with medium gauge nylon or similar non-absorbable suture
  • the tube is secured by tying or taping it to the neck
  • at the point of contact of tube and skin, padding should be placed to prevent rubbing. It should be replaced daily.

An alternative approach is non-surgically and percutaneously:

  • local anaesthetic is infiltrated at the same site
  • a stylet is inserted through to the trachea
  • successively larger dilators are put over the top of the stylet until a hole large enough to pass a tracheostomy tube is attained
  • the tube is placed into the trachea and secured in place by inflation of the balloon

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