# Pediatric Tracheostomy in a 7 year old child Dr. Tamer Ashraf Wafa — GCMD Library

<p>In this video, Tracheostomy is demonstrated in for a seven year.The indication for the procedure was prolonged intubation. The video shows the surgeon's point of view (POV).<br> This video is intended as an education material ans should not replace formal surgical training.<br> In this procedure, the operative steps are played in normal speed while some of the steps is played in faster speed for illustration purpose.The original video is 37 minutes.<br> Surgical steps a described in the subtitles during the video. This is an educational video designed for junior pediatric surgeons in training.</p> <p>Tamer Ashraf Wafa PhD, MRCS<br> Assists Professor, Pediatric Surgery Department<br> Mansoura University</p><p><a href="http://videolibrary.globalcastmd.com/pediatric-tracheostomy-in-a-7-year"></a></p>

Type: video · 2 min · posted 2021-06-18
Canonical: https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151

## Chapters
- [0:00](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=0) Incision and Superficial Dissection
- [0:50](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=50) Deep Dissection and Thyroid Isthmus
- [1:40](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=100) Tracheal Exposure and Opening
- [2:30](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=150) Tube Insertion and Wound Closure

## Statements
- "In a 7-year-old boy, a 2-centimeter transverse incision is placed midway between the cricoid cartilage and the suprasternal notch for tracheostomy." — Tamer Ashraf Wafa (clinical) [0:00](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=0)
- "If the anterior jugular vein is encountered during tracheostomy, it is coagulated and cut." — Tamer Ashraf Wafa (clinical) [0:30](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=30)
- "The deep cervical fascia is split in a vertical fashion during pediatric tracheostomy." — Tamer Ashraf Wafa (clinical) [0:40](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=40)
- "The thyroid isthmus can be cauterized and divided, or retracted downwards." — Tamer Ashraf Wafa (clinical) [1:00](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=60)
- "In children, the third and fourth tracheal rings are the best level for tracheostomy opening." — Tamer Ashraf Wafa (clinical) [1:30](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=90)
- "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." — Tamer Ashraf Wafa (clinical) [1:40](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=100)
- "The side of the tracheal incision is cauterized with bipolar diathermy to minimize bleeding." — Tamer Ashraf Wafa (clinical) [1:55](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=115)
- "The trachea is sharply incised vertically for tracheostomy." — Tamer Ashraf Wafa (clinical) [2:05](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=125)
- "Suction should be continuously applied during tracheal incision to prevent blood from entering the airway." — Tamer Ashraf Wafa (clinical) [2:10](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=130)
- "Pulling the stay sutures laterally helps opening the tracheal lumen." — Tamer Ashraf Wafa (clinical) [2:20](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=140)
- "The tracheal opening should be widened just enough to admit the suitable tube." — Tamer Ashraf Wafa (clinical) [2:25](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=145)
- "The endotracheal tube is pulled back to the level of the tracheostomy opening before inserting the tracheostomy tube." — Tamer Ashraf Wafa (clinical) [2:30](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=150)
- "After tracheostomy tube insertion, air entry is checked on both lungs." — Tamer Ashraf Wafa (clinical) [2:40](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=160)
- "The angles of the tracheostomy wound are approximated using absorbable sutures." — Tamer Ashraf Wafa (clinical) [2:45](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=165)
- "The neck is flexed and the tracheostomy tube is tied tightly around it." — Tamer Ashraf Wafa (clinical) [2:50](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=170)
- "The stay sutures are taped to the chest and should not be removed, as written clearly on the tape." — Tamer Ashraf Wafa (clinical) [2:53](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=173)

## Transcript
 This video shows a tracheostomy in a 7-year-old boy. With the neck extended, a 2-centimeter transverse incision is placed, midway between the cricoid cartilage and the suprasternal notch. The skin is incised and the superficial fascia is divided. If the anterior jugular vein is encountered, it is coagulated and cut. The deep cervical fascia is split in a vertical fashion. The strap muscles are seen, and the midline fascia in between is divided. The thyroidismus is now in view. It can be cauterized and divided, or, it can be retracted downwards. The pre-tracheal fascia is cleared off the trachea in order to expose the tracheal rings. The tracheal rings are counted, in order to choose the level of the opening. In children, the third and fourth rings are the best level. Two stay sutures are placed on both sides of the opening. They are non-absorbable, and are left in place for post-operative reinsertion of the tube if needed. The side of the incision is cauterized with bipolar diathermy, to minimize bleeding. Then, the trachea is sharply incised vertically. Suction should be continuously applied, to prevent blood from entering the airway. Pulling the stay sutures laterally helps opening the lumen. The opening should be widened, just enough to admit the suitable tube. The endotracheal tube is now seen, and is pulled back to the level of the opening. The tracheostomy tube is gently inserted into the trachea. The ventilator is then connected to the tube, and the air entry is checked on both lungs. The angles of the wound, are approximated using absorbable sutures. Then, the neck is flexed and the tube is tied tightly around it. The stae sutures are taped to the chest, and don't remove as written clearly on the tape. Thank you for watching. Subscribe to see the upcoming videos.

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Not medical advice · citation policy: https://library.globalcastmd.com/ai