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Percutaneous dilational tracheostomy (Procedure: Ciaglia's…
Percutaneous dilational tracheostomy
Indication
Bypass of glottis or supraglottic obstruction
Access for tracheal toilet
More comfortable airway for prolonged ventilator support
Protection of airway from aspiration
Contraindications
Coagulopathy
Significant autonomic abnormality in anterior neck
Previous tracheostomy scar
Unstable cervical spine injury
Procedure: Ciaglia's percutaneous technique
Adequate skin incision around second tracheal ring
Blunt dissection down to trachea with forceps
ETT withdrawn so cuff lies just above vocal cords - fibreoptic bronch may be used to help guide wire placement
Operator confirms ETT above stoma site by palpation of trachea
Needle through membrane above or below second tracheal ring, J-wire passed through this
Series of curved dilators or tapered dilator used to progressively enlarge stoma
Trache tube inserted, position confirmed
ETT removed
Complications
Immediate
Procedural complications
Tracheal wall injury
Surgical emphysema, pneumothorax, air embolus
Tracheal ring fracture
Bleeding
Misplacement of tube
Loss of airway
Misplacement into pretracheal tissue
Right main bronchus intubated
Occlusion of tip against tracheal wall
Compression of tube lumen by cuff herniation
Delayed
Blockage with secretions
Infection
Pressure injuries
Mucosal ulceration and perforation
Erosion into vessels, bleeding
Tracheo-oesophageal injury
Late
Tethering, minor cosmetic problems
Tracheal and laryngeal stenosis
Persistent sinus at trache site
Tracheomalacia, tracheal dilatation