Understanding Percutaneous Tracheostomy Procedure
- Jadumani Singh
- 3 days ago
- 2 min read
Performing a tracheostomy is one of the most critical skills in acute and critical care medicine. It provides an alternative airway for patients who require prolonged ventilation or have upper airway obstruction. Over the years, the percutaneous tracheostomy has become the preferred method in many intensive care units, valued for its minimally invasive technique and bedside feasibility.
Understanding the Tracheostomy Procedure
A tracheostomy involves creating an opening in the neck to insert a tube directly into the trachea, allowing air to bypass obstructions or facilitate long-term ventilation. The percutaneous technique is commonly performed under local anaesthesia with sedation, making it suitable for ICU settings.
Key Steps in the Procedure
Patient Preparation – Confirm indication, obtain informed consent, and position the patient supine with neck extended.
Instrument preparation - Portable disposable bronchscope and difficult airway trolley
Anatomical Identification – Palpate the cricoid cartilage and identify the tracheal rings, marking the site between the second and third rings.
Local Anaesthesia & Incision – Administer local anaesthetic and make a small horizontal incision.
Needle Insertion & Guidewire Placement – Insert a needle into the trachea under aspiration, then advance a guidewire.
Dilation & Tube Insertion – Use serial dilators or a single tapered dilator over the guidewire before inserting the tracheostomy tube.
Confirmation & Securing the Tube – Confirm placement using auscultation and capnography, then secure and dress the site.
Each step demands precision, team coordination, and a strong understanding of airway anatomy.
⚠️ Safety Considerations
Performing a tracheostomy safely requires more than just technical skill — it demands preparation and situational awareness.
Avoid in patients with distorted anatomy, infection at the site, or coagulopathy.
Ultrasound Guidance: Enhances accuracy and reduces complications.
Requires a skilled operator, assistant, and monitoring personnel.
Sterile Technique: Essential to minimise infection risk.
Always have rescue airway equipment on hand.
Maintaining these standards ensures safety and procedural success.
🏥 Post-Procedure Care
Ongoing tracheostomy care is crucial to prevent complications and promote healing.
Daily Stoma Care and regular dressing changes
Humidified oxygen to protect the mucosa
Careful suctioning to clear secretions
Monitoring for bleeding, infection, or displacement
Patient and caregiver education for long-term management
These practices shorten hospital stay, reduce infection risk, and improve patient comfort.
💻 The Role of Technology and Digital Training
Technology continues to transform procedural medicine — and tracheostomy is no exception. Ultrasound imaging, digital documentation, and simulation-based e-learning have made training safer and more accessible.
Watch the recorded webinar on percutaneous tracheostomy
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