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To the Editor.—I agree with Dr Robert B. Lewy (Archives 1982;108:327) that tips and techniques should not be left only to "oral tradition" and I appreciate his describing his fail-safe method for tracheotomy tube replacement. I have found a variation of this technique to be useful for placing a tube into a "fresh" tracheotomy.
Usually at the completion of a tracheotomy, the fenestra in the trachea is fully visible and there is no difficulty in inserting the tube. Sometimes, especially in patients with short or thick necks, or in patients whose necks cannot be extended, the fenestra may not be easy to expose and the tube may not "want" to enter the trachea. If the tracheotomy must be performed over an unsupported airway, or if an inexperienced anesthesiologist has withdrawn the endotracheal tube before the tracheotomy tube is in place, this situation can be dangerous.
To insert a tracheotomy
GOODMAN RS. Tracheotomy Tube Replacement. Arch Otolaryngol. 1983;109(4):277. doi:10.1001/archotol.1983.00800180075021