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formal tracheostomy, Step by step
- Put a small pillow under the patient’s shoulders to extend the neck, this makes the larynx more prominent
- Identify the landmarks (thyroid and cricoid cartilage) and make a transverse skin incision over the second tracheal ring. This is usually 2 cm below the border of the cricoid cartilage
- Subcutaneous dissection towards the fascia (i.e. median fibrous raphe)
- Vertically opening the raphe
- Further dissection towards trachea
- Isthmus of the thyroid can be retracted when small or divided when large and interfering with the dissection
- Blunt dissection of the trachea
- Identify second tracheal ring and place suture through it. Don't cut the needle yet
- Create treachea flap and turn it downwards
- Retract endotracheal tube
- Insert cuffed tracheostomy tube
- Inflate the cuff
- Remove the obturator, and replace it by the inner tube
- Connect the tube to respirator
- Suture the trachea flap to the skin
- Bring skin together on both sides with a suture
- Place a gauze around the tube
- Secure tube with a tape/band around patient's neck
- Check cuff pressure
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