Pediatric Tracheostomy in a 7 year old child Dr. Tamer Ashraf Wafa

In a 7-year-old child, a 2-centimeter transverse incision is placed midway between the cricoid cartilage and the suprasternal notch for tracheostomy.

If the anterior jugular vein is encountered during tracheostomy dissection, it is coagulated and cut.

The deep cervical fascia is split in a vertical fashion during pediatric tracheostomy.

The thyroid isthmus can be cauterized and divided, or retracted downwards during tracheostomy.

In children, the third and fourth tracheal rings are the best level for tracheostomy opening.

Two non-absorbable stay sutures are placed on both sides of the tracheostomy opening and left in place for post-operative reinsertion of the tube if needed.

The side of the tracheal incision is cauterized with bipolar diathermy to minimize bleeding.

The trachea is sharply incised vertically for tracheostomy.

Suction should be continuously applied during tracheal incision to prevent blood from entering the airway.

Pulling the stay sutures laterally helps opening the tracheal lumen during tube insertion.

The tracheostomy opening should be widened just enough to admit the suitable tube.

The endotracheal tube is pulled back to the level of the tracheostomy opening before inserting the tracheostomy tube.

After tracheostomy tube insertion, the ventilator is connected and air entry is checked on both lungs.

The angles of the tracheostomy wound are approximated using absorbable sutures.

The neck is flexed and the tracheostomy tube is tied tightly around it for secure fixation.

The stay sutures are taped to the chest with clear labeling not to remove them.