INTRA-TRACHEAL IRRIGATION 65 



A second method of operation, illustrated in Fig. 23, con- 

 sists in making a transverse incision through the inter- 

 annular ligament between the two last exposed tracheal 

 rings the length of the diameter of the tube to be inserted. 

 Make a perpendicular inciMon upward from each end of 

 this at a point i to 1.5 cm. from the median line through 

 one or two tracheal rings, according to the size of the tube. 

 With forceps or tenaculum grasp the segments of partially 

 detached cartilage and remove them by cutting through the 

 inter-annular ligament. 



A third, and to us preferable, method is to insert a narrow- 

 bladed scalpel transversely at about the lower third of the 

 lowermost bared tracheal ring and cutting outward and 

 upward in a curved line, to pass through the first inter- 

 annular ligament and continue into the- succeeding segment 

 until near its superior border, when the incision is curved 

 downward to eventually reach the starting point, the isolated 

 section of the trachea being securely grasped with a pair of 

 forceps before its excision is completed. By this method 

 no tracheal ring is severed. 



The trachea tube is to be removed and cleansed daily as 

 long as its use is necessary, and when discontinued the 

 wound should be left open and dressed with antiseptics. 



15. INTBA-TBACHEAIi IBBIGATION 

 Objects. The washing out of oils or other insoluble or 

 irritant substances accidentally introduced into the trachea 

 and bronchi while drenching or otherwise, and the disin- 

 fection of the trachea and bronchi. 



Instruments. Same as for tracheotomy, and a gravity 

 irrigating apparatus fitted with 3 m. of rubber tubing about 

 I cm. in diameter, 5 liters of .6 per cent, sodium chloride 

 solution at a temperature of 37 to 39° C. In cases of sup- 

 purative bronchitis, peroxide of hydrogen may be added 

 to the solution. 



