Tracheostomy tube insertion is performed in two ways: Surgical or Percutaneous.

Surgical/ Classic Procedure An open approach where the Trachea is open through the front of the neck and inner organs, or tissue can be seen. The procedure is performed in the theatre with patient under GA. Especially with Paediatric patients.

Benefits:

• Inserted under direct supervision
• Best control of airways and surrounding structures
• Availability of needed equipment

Percutaneous procedure A close approach of medical procedure where access to inner organs or other tissue is done via needle-puncture using Seldinger technique and bronchoscopic guidance to open the trachea with plastic dilator.

Benefits:

• Minimal invasion
• Bedside operation on ICU
• No transportation of clinically ill patients
• Simple and cost effective

Tracheostomy procedure is always performed between the 2nd and 3rd or 3rd and 4th trachea ring/cartilage as demonstrated in the diagram.