Percutaneous Dilational Tracheostomy - Procedure Instructions Checklist
Tracheostomy is to establish a definitive surgical opening into the trachea. It is commonly performed in the ICU for patients requiring prolonged ventilatory support.
Position: neck extension with a roll placed in between scapula
Sterilize and drape anterior neck
Landmarks: Palpation, Bronchoscopic ± ultrasound identification of tracheal rings. 2nd and 3rd tracheal ring ideal insertion site.
Local Analgesia: Lidocaine w or w/o epinephrine into SC tissue
Steps:
 • Make 2 cm vertical skin incision, can be done after guidewire advanced if preferred.
 • With bronchoscope identify tracheal rings and thyroid cartilage. Withdraw ETT above level of needle insertion site.
 • Insert needle midline, 12’oclock during direct visualization. Advance J guidewire. Use mall 14 Fr dilator over guidewire.
 • Single-stage tracheal dilator over guidewire, remove.
 • Tracheostomy tube is inserted with the loading dilator over the guidewire.
 • Bronchoscopic confirmation of tracheostomy tube position. Tracheostomy tube is connected to the ventilator.
 • Tracheostomy secured with sutures (optional) and neck ties.

by Nick Mark MD @nickmmark

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