Mini Tracheostomy

OVERVIEW

  • narrow bore tracheostomy tube inserted through the cricothyroid membrane

USE

Uses include:

  • Suction therapy for sputum retention
  • Weaning off IPPV
  • Maintain stoma patency (so that emergency reinsertion of tracheostomy is possible)
  • Emergency airway and oxygen delivery

DESCRIPTION

e.g. Portex Mini Trach II

  • Guarded scalpel allows correct midline incision to be made with minimal risk of damage to the posterior tracheal wall
  • Curved introducer aids introduction of the cannula
  • 4mm ID, thermosensitive, Blue Line Cannula
  • Neck tapes for secure fixation of the Cannula to the neck
  • 10F Suction Catheter
  • Low friction endobronchial catheter for initial suctioning following cannulation

CONTRAINDICATIONS

  • Inadequate spontaneous ventilation
  • Age <12 years
  • Coagulopathy
  • Platelets <100,000/mm
  • Marked uraemia
  • Gross obesity or obscure anatomy
  • Calcified larynx

METHOD OF USE / INSERTION

Insertion

  • standard precautions and patient preparation
  • full neck extension
  • identify cricothyroid membrane
  • use Seldinger technique with serial dilation as for standard percutaneous tracheostomy (Ciaglia technique), but insert through the cricothyroid membrane
  • On completion of procedure, apply tracheostomy dressing and secure MiniTrach tube with tracheostomy tapes
  • suction aseptically

COMPLICATIONS

  • Bleeding
  • infection
  • tracheal damage
  • pneumothorax
  • pain
  • tracheal transection

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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