A technical modification for percutaneous tracheostomy: prospective case series study on one hundred patients

Abstract

The purpose of this study is to describe a technical modification of percutaneous tracheostomy that combines principles of the Percu Twist™ and the Griggs-Portex® methods in a reusable kit. One hundred patients underwent the procedure. There were no false passage, tube misplacement, or deaths related to the procedure. There were two minor bleedings managed conservatively. The technical modification described in this study is safe and simple to execute.

Figure 1

The instruments used for percutaneous tracheostomy. (A) The 14G intravenous catheter- Jelco^®; (B) the guidewire; (C) the threaded tip dilator; (D) the self retaining retractor; (E) the spherical tip flexible introducer.

Figure 2

Ultrasound image of the trachea. Longitudinal view of the trachea shows the cricoid cartilage and the tracheal rings; important anatomical references to localize the site of puncture of the trachea. The endotracheal tube has been pulled back. I, II, III (first, second, and third tracheal rings); image obtained with an 8 MHz vascular probe.

Figure 3

The guidewire in position. The guidewire is passed into the tracheal lumen through the 14 G intravenous catheter.

Figure 4

The threaded tip dilator. Picture (A) shows the threaded tip dilator in the incision. Insert (B) depicts how the guidewire, passing through the tip of the threaded dilator, prevents the threads from "catching" other structures.

Figure 5

The self-retaining retractor. Insert (A) depicts how the self-retaining retractor is passed over the guidewire in locked position. Picture (B) shows how the retractor enables hands free lateral retraction of the pre-tracheal soft tissue, and the aperture on the anterior tracheal wall. The limiter ridge prevents insertion of the retractor too far into the trachea.

Figure 6

The spherical tip flexible introducer. Insert (A) depicts the elastic property of the introducer constructed with a circular helical spring. Picture (B) shows the flexible introducer positioned in the trachea facilitated by the self-retaining retractor.

Figure 7

Insertion of the tracheostomy tube in the trachea. Picture shows the insertion of the tracheostomy tube in the trachea over the spherical tip flexible introducer. Arrow depicts the guidewire inside the introducer.