Percutaneous tracheostomy Singledilator Griggs technique Dr S Moied

Percutaneous tracheostomy Single-dilator / Griggs technique Dr. S. Moied Ahmed Associate Professor & Incharge ICU Deptt. of Anaesthesiology & Critical Care JN Medical College AMU, Aligarh

• Optimal ventilatory setting • Spo 2, ECG, BP, ETCO 2 monitoring • Extended neck with transverse shoulder roll • Patient should be adequately sedated and adequate NMJ blockade should be used

Land mark for PCT Ø Thyroid cartilage Ø Cricoid cartilage Ø Tracheal rings Ø Sternal notch

Videobronchoscopy

Bronchoscopic Tracheal Transillumination

1%Xylocaine with Epinephrine infiltered about 1 cm below the cricoid cartilage

1 -1. 5 cm horizontal incision made in the skin

Blunt dissection by fine haemostat

• Tip of the index finger is used for blunt dissection and identification of tracheal rings • Thyroid should be palpated and avoided from the surgical field

The introducer needle is advanced into the tracheal lumen with continuous aspiration

Air aspirated in the syringe Needle inside the trachea

Guidewire introduced through the needle sheath

Short (11 F) tracheal dilator is advanced over guide wire by rotational movement

Griggs technique

Howard Kelly’s Forceps

Single Dilator – White Tusk Hydrophilic coating Soft Tip Grooves Safety mark

A guiding catheter is passed over the guide wire which forms a unit and over this unit a single dilator is passed.

Distal end of single stage dilator should be immersed into water or saline to activate lubricious hydrophilic coating on the dilator

Dilator is passed over the guiding catheter unit

Single stage dilator is introduced in an arc like motion over the guiding catheter unit

Tracheal stoma is dilated to a size appropriate for the tube to be inserted by moving dilator to and fro

Portex purple introducer with soft tip is used for introduction of tracheostomy tube

Lubricated tracheostomy tube loaded over introducer

Loaded tracheostomy is inserted to tracheal stoma over guiding wire Slight twisting movement may be required

Tracheostomy tube in place Tracheostomy tube flanges and connecter should be held firmly to minimise traction on the tube

Breathing system transferred to tracheostomy tube

2 13 3 11 5 4 1 12 1 9 6 7 8 10

One technique you should learn? -Crico