cannula. The stepless transition assures an easier
p
assage and thus atraumatic insertion of the tube.
-
The position of the tracheostomy tube should be
checked by brochoscopic visual inspection and/or
by chest X-ray.
- After ensuring the tube is in the correct position,
v
entilation by the endotracheal tube is changed to
the tracheostomy tube; only then the latter is allowed
to be blocked. If there is blocking of the tracheosto-
my tube during ventilation via the endotracheal tube,
there is an acute danger of neck emphysema.
4. Instructions for Use
4.1 Preparation of the TRACOE
®
experc Sets
(Dilation Set and Tube Set)
1. After removal from the packaging, the dilation set
and the tube set are checked for completeness and
functionality.
2. Check the cuff of the tracheostomy tube for leaks
by a test inflation. If it proves to be airtight, deflate
the cuff completely while pushing it upwards to-
wards the flange in order to facilitate insertion of the
tube.
3. For the TRACOE
®
vario tubes, after pressing the
spring element, turn the flange to set it in the correct
horizontal position.
To design the flange locking device as safe as pos-
sible, a lever system was developed. If the lever is
pushed upwards, this provides an additional locking
function for the flange on the tube ; If it is pushed
downwards, the locking function is released and
the flange can be pushed along the tube by press-
ing the spring element as described above.
4. Check
- when using the dilation set (REF 520) that the guide
wire can be advanced without obstruction through
the short 14 CH/FR dilator, and
- when using the TRACOE
®
twist plus/TRACOE
®
vario
tube sets (REF 330, 331, 332, 888-332, 420, 421,
422, 423, 424 and 425) that the guide wire can also
be advanced without obstruction through the guid-
ing catheter with radio-opaque, collapsible silicone
sleeve.
WARNING: The atraumatic inserter or the atraumat-
ic insertion system contained in the tube must only
be used with its appropriate tracheostomy tube
and with the correct size. The size is marked on the
inserters.
4.2 Patient Preparation
1. The patient should be examined for anatomical
anomalies of the blood vessels in the neck region.
2. Patient position: on back with a pillow beneath the
s
houlders with head and neck stretched (see Fig.
3
); the head part of the patient’s bed should be
raised by 30-40º.
3. Disinfecting the skin in the neck region and cov-
e
ring with sterile drapes.
4. Patient sedation and monitoring of vital functions
(oximetry, capnography, ECG, blood pressure
measurement).
5
. Prior to surgery, the pharynx should be suctioned,
in case an endotracheal tube is used for ventilation
it should be unblocked and the tube with the cuff
area withdrawn as far as the entrance of the larynx
(approx. 1 cm). Withdrawing the tube prevents the
tube cuff from being pierced during tracheal punc-
ture. The cuff of the endotracheal tube is reinflated if
necessary and ventilation adjusted with respect to
volume per minute.
4.3 Implementation
4.3.1 Intervention
1. Palpation of the orientation points (cricoid cartilage,
conic ligament, tracheal ring), where necessary
making skin marking in the planned incision area. The
puncture and subsequent placing of the tube takes
place typically between the 2. and 3. or the 3. and 4.
tracheal ring (see Fig. 4 and 5).
2. After infiltration of a local anaesthetic (e.g. 1%
Lidocaine with adrenaline) a 1.5 – 2 cm long incision
is made across the site of placement (see Fig. 5).
Then careful blunt preparation takes place on to the
anterior wall of the trachea. If necessary, the mid-line
of the trachea is freed of tissue and then the cricoid
cartilage palpated. If necessary, additional local
anaesthetic can be injected into the prepared region.
If the thyroid gland isthmus is located in the prepara-
tion area, this should be carefully pushed downwards.
3. The intervention should take place under broncho-
scopic control. This can reduce the risk of injuries to
the trachea.
4. The puncture of the trachea typically takes place
between the 2. and 3. or the 3. and 4. tracheal ring in
a caudal direction. To do this a puncture cannula is
used with a Teflon catheter and an attached syringe
filled partly with sterile saline solution or sterile water.
Push the puncture tube as far forward in a posterior
and caudal direction until air bubbles can be drawn
in. The tube should now be tilted at an angle of
approx. 60º vis à vis the anterior wall of the trachea
(see Fig. 6).
8
TRACOE percutan
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