Tracheostomy Instrument Set — Surgical Tools for Airway Management

Tracheostomy is performed in two distinct clinical contexts — emergency (trauma bay or ICU bedside, no time for a complete OR setup) and elective (planned surgical tracheostomy with a full scrub team). The instrument sets for each context are quite different, and most procurement teams need both configurations available.

Elective Surgical Tracheostomy Instrument Set

A planned open tracheostomy set for OR use contains 25 to 35 instruments. Here is the standard configuration:

Retractors

• Langenbeck retractors (pair, 19 mm blade width) — initial skin, platysma, and strap muscle retraction
• Weitlaner self-retaining retractor — holds the pretracheal wound open without an assistant during dissection and tube insertion; the ratchet mechanism locks at the required depth
• Tracheal hook (cricoid hook) — a single-prong hook that elevates the anterior tracheal ring to expose the tracheal window; the most commonly omitted instrument in budget sets, and one of the most important

Tracheal Access Instruments

• Trousseau tracheal dilator — dilates the tracheal incision to the diameter required for the selected tracheostomy tube; the hinged design controls the degree of dilation incrementally, avoiding over-dilation
• Laborde tracheal dilator — an alternative to the Trousseau used in some hospital protocols; three-prong design allows simultaneous lateral and superior dilation

Scissors and Scalpels

• Metzenbaum scissors, curved, 18 cm — pretracheal fascial dissection and separation of the strap muscles in the midline
• Mayo scissors, straight — cutting the tracheal membrane and extending the tracheal window
• Scalpel handles No. 3 and No. 4 — skin incision and tracheal cartilage window

Clamps and Forceps

• Mosquito clamps (4 pcs, curved) — fine vessel hemostasis in the thyroid isthmus and pretracheal fascia where heavy hemostats would cause tissue damage
• Kelly hemostatic forceps (4 pcs) — standard hemostasis throughout the dissection
• Allis tissue forceps (2 pcs) — for retracting the thyroid isthmus if it overlies the planned tracheal window
• Adson tissue forceps — skin and subcutaneous tissue handling

Needle Holders and Closure

• Mayo-Hegar needle holders (2 pcs) — for tracheostomy tube-anchoring stay sutures placed through the tracheal cartilage and skin closure

Why the Tracheal Hook Is Non-Negotiable

The tracheal hook (cricoid hook) is frequently left out of low-cost tracheostomy sets because it looks like a simple single-prong instrument. But without it, the trachea can recede into the pretracheal soft tissue at the moment the tracheal incision is made — especially in patients with short necks, significant adipose tissue, or prior thyroid surgery that created scarring around the trachea. When the trachea drops, the tracheostomy tube cannot be placed without forceful blind probing, which increases the risk of false passage.

The standard configuration is a 4 mm single-prong hook with a 90-degree bend 12 mm from the tip. All Fizza Surgical tracheostomy sets include the tracheal hook as a standard item, not an optional add-on.

Trousseau Dilator Compatibility

Our Trousseau and Laborde dilators are compatible with all major tracheostomy tube brands including Portex, Shiley, Tracoe, and Smiths Medical. The standard dilator range accommodates tube internal diameters from 6.0 mm to 10.0 mm. For paediatric tracheostomy sets with tubes from 3.0 mm to 5.0 mm, contact us for our paediatric tray configuration.

Percutaneous Dilatational Tracheostomy (PDT)

Bedside PDT uses a Seldinger-technique approach with a guidewire and serial or single-step dilators — a different instrument category from open surgical tracheostomy. Fizza Surgical manufactures the surgical (open) tracheostomy sets described above. For PDT procedure packs or bronchoscopy-guided bedside kits, contact us to discuss requirements.

Material Quality and Sterilization

All instruments are manufactured from 316L stainless steel under ISO 13485:2016 quality management with CE marking. Sets are validated for steam autoclave sterilization at 134 degrees Celsius and are compatible with gamma irradiation-compatible packaging for hospitals requiring pre-sterilized instrument packs.

Emergency Tracheostomy Tray: Minimum Viable Contents

The elective set above assumes a scrub team, good lighting and an anaesthetised patient with a secured airway. The emergency configuration assumes none of those things. It lives on a resus trolley or in an ICU drawer, it gets opened by whoever is standing there, and everything in it has to be usable by one operator with an assistant holding a torch.

Stripping the 25–35 instrument elective tray down to what is genuinely load-bearing gives a set of roughly eight to twelve items:

• Scalpel handle No. 3 with No. 10 or No. 15 blade — a single vertical midline skin incision from cricoid to sternal notch
• Tracheal (cricoid) hook, single prong — the one instrument that cannot be improvised, and the reason a bedside kit without it is not a tracheostomy kit
• Trousseau tracheal dilator — the hinged pattern is preferred here because it dilates incrementally under control; see our Trousseau dilator guide for the sizing detail
• Curved mosquito clamps, 2 pcs — blunt dissection through the pretracheal fascia and control of the anterior jugular veins
• Kelly or Crile hemostat, 2 pcs
• Small self-retaining retractor — a compact Weitlaner substitutes for a second assistant
• Toothed tissue forceps
• Mayo-Hegar needle holder and suture for stay sutures and tube anchoring
• Straight Mayo scissors

What comes out of the set matters as much as what stays in. The Laborde dilator, the Allis forceps, the second pair of Langenbecks and the full complement of eight hemostats are all elective-tray items. In an emergency they add search time to a tray that is being used under pressure, and search time is the resource in shortest supply.

Two practical points on emergency tray design. First, keep the count low enough that a single glance confirms completeness — a nine-item tray can be verified in two seconds, a thirty-item tray cannot. Second, the tray should be laid out in order of use rather than by instrument family, so the sequence runs left to right: blade, hook, dilator, clamps, needle holder. Units that reorganise their emergency trays this way consistently report faster time-to-tube in simulation.

For the wider emergency airway context, including cricothyrotomy instrumentation and the surgical airway sets that sit alongside this tray, see our guide to the emergency tracheostomy kit.

2026 Update: Tube Compatibility & Quick-Reference Specs

To make tray specification faster, here is a consolidated compatibility reference for the dilators and tubes covered above, followed by the questions procurement teams most often raise when standardising a tracheostomy set.

For airway management beyond the tracheostomy tray itself, see our laryngoscope range and the broader surgical instrument catalogue.

Contact Fizza Surgical to request a tracheostomy set catalog or to order a sample tray for evaluation.