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 #Percutaneous #Dilational #Tracheostomy #criticalcare #pulmonary #checklist #management #procedure
