Percutaneous tracheostomy at the bedside: 13 tips for improving safety and success

Bryan G. Maxwell, Toni Ganaway, Geoffrey K. Lighthall

Research output: Contribution to journalArticlepeer-review

Abstract

We have developed a set of routines and practices in the course of performing a large series (n = 70) of percutaneous dilational tracheostomy (PDT). The 13 tips discussed in this review fall into 4 categories. System factors that facilitate training, patient safety, and avoidance of crises including the use of appropriate personnel, importance of timing, use of premedication, and the utility and content of a preprocedure briefing. Suggestions to prevent loss of the airway include tips on airway assessment, preparation of airway equipment, and use of exchange catheter techniques. Strategies to avoid and manage both microvascular and large-vessel bleeding are discussed. We also discuss the management of common postprocedure problems including tracheostomy tube obstruction, malposition requiring tube exchange or replacement, and air leak. The practical considerations for successful execution of PDT involve common sense, thorough planning, and structured approaches to prevent adverse effects if the procedure does not go as smoothly as expected. These strategies will aid anesthesiologists and intensivists in improving their comfort level, safety, and competence in performing this beside procedure.

Original languageEnglish (US)
Pages (from-to)110-115
Number of pages6
JournalJournal of Intensive Care Medicine
Volume29
Issue number2
DOIs
StatePublished - Jan 1 2014

Keywords

  • Blue Rhino
  • ICU tracheostomy
  • bedside tracheostomy
  • percutaneous dilational tracheostomy
  • percutaneous tracheostomy
  • procedure checklist
  • safety

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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