The incision site of tracheostomy is?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Medical & Surgical Nursing

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Explanation

The standard and safest site for a tracheostomy incision is between the second and third tracheal rings.
This location provides a safe window, as it is situated below the cricoid cartilage, reducing the risk of subglottic stenosis.
It is also sufficiently high above the innominate artery, minimizing the risk of a catastrophic bleed from a tracheo-innominate fistula.

Option A: An incision at the 1st and 2nd rings is too high. It risks damaging the cricoid cartilage, which is the only complete cartilaginous ring in the airway and is crucial for structural support.
Option C: An incision at the 5th tracheal ring is too low. As the trachea descends into the chest (thorax), it comes into close proximity with the innominate artery (brachiocephalic trunk).
Option D: Similar to the 5th ring, an incision at the 6th tracheal ring is dangerously low and deep within the superior mediastinum.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Anatomical location for tracheostomy incision as background academic context rather than a clinical decision trigger.
A nurse caring for a patient with a new tracheostomy must monitor for signs of complications, including bleeding from the site, subcutaneous emphysema (air trapped under the skin), and respiratory distress, which could indicate tube displacement.
It is a critical nursing responsibility to ensure that emergency equipment is always at the bedside of a patient with a tracheostomy. This includes a spare tracheostomy tube of the same size and one size smaller, an obturator, and suction equipment.
What if? If a patient with a tracheostomy tube accidentally dislodges it (decannulation), the nurse's first action is to call for help and attempt to re-insert the tube or a spare one using the obturator, while assessing the patient's respiratory status. Maintaining a patent airway is the top priority.

How to Approach the Question

First, identify the key terms in the question: 'incision site' and 'tracheostomy'. This directs you to recall knowledge about a specific surgical procedure.
This is a factual recall question. Access your knowledge of neck anatomy, specifically the relationship between the larynx, trachea, thyroid gland, and major blood vessels.
Visualize the trachea in the neck. Consider the structures you want to avoid: the cricoid cartilage and vocal cords (too high) and the great vessels like the innominate artery (too low).
Evaluate the options based on this 'safe window' concept.
Eliminate the options that are too high (1st ring) and too low (5th and 6th rings) due to the significant risks of complications.
Select the option that represents the standard, safest location for the procedure, which is between the 2nd and 3rd tracheal rings.

Concept Tested & Keywords

Q9Cbs0TLR9HJGoL1unlx0V

E6 Nursing Fundamentals Taylor p. 736-738

E6 Anatomy Applied Ashalatha 4e p. 98-100