Tracheotomy with tracheostomy tube placement in dogs

Summary

The video demonstrates a canine tracheotomy and placement of a tracheostomy tube. The procedure can provide an airway when breathing through the upper airway is obstructed or at risk.

Indications and tube care

Potential indications include life-threatening or anticipated upper-airway obstruction caused by trauma, neoplasia, or a functional problem such as laryngeal paralysis. A tracheostomy tube may also allow inhalant anesthesia for surgery of the upper airway or oral cavity, or provide prolonged ventilatory support.

Tube placement requires intensive, around-the-clock care because mucus or blood can obstruct the tube. An endotracheal tube may be used through an emergency tracheotomy incision to establish an airway. A tube designed for tracheostomy use can make ongoing care easier; tubes with a removable inner cannula can be cleaned and replaced. Tubes without one require frequent suctioning and saline installation.

Procedure described

1. Position and prepare the patient. Place the dog on its back and identify the ventral midline of the neck. If the airway can first be controlled by standard intubation, clip and aseptically prepare the neck. In a life-threatening emergency, preparation may not be possible.
2. Expose the trachea. Make a skin incision on the ventral cervical midline and sharply dissect the subcutaneous tissue, staying on the midline. Divide the paired sternohyoid muscles between their bellies and use retractors to improve exposure.
3. Choose the tracheal incision site. The video describes an incision around the fourth through sixth tracheal rings. An incision too close to the larynx may increase coughing; one too near the thoracic inlet can make tube care more difficult.
4. Make the tracheotomy opening. Either a longitudinal incision through three adjacent rings or a transverse incision through the annular ligament between rings is described as acceptable. The transverse incision should not extend beyond 60% of the tracheal circumference.
5. Place a safety suture and insert the tube. Place a suture around a tracheal ring and leave it long and accessible. It helps expose the trachea during incision and provides a way to regain access quickly if the tube becomes displaced.
6. Manage the cuff appropriately. The cuff is generally left deflated when the tube is being used as an airway adjunct. The narration says to inflate it when anesthesia is delivered through the tube or the animal is ventilated.
7. Secure the tube and close the incision. Secure the tube with umbilical tape around the neck; additional sutures between the skin and the tube’s cuff area may be used. Loosely appose the sternohyoid muscle bellies rather than closing them tightly around the tube. The skin can be closed routinely, such as with staples, while avoiding tight closure around the tube.
8. Remove the tube and care for the wound. In most cases, remove the tube within 24–48 hours, once the underlying problem is adequately treated and the dog can breathe normally. After removing the tube and its ties or sutures, allow the wound to heal by second intention. Keep it clean and use petroleum jelly around the skin to prevent chafing. Remove the safety suture once normal ventilation is confirmed.

Speakers and sources featured

• Dr. Don Waldron — procedural demonstrator and narrator, identified in the video context.
• No other speakers are identifiable in the subtitles.