Percutaneous tracheostomy: What to know

Share on Pinterest

Doctors perform percutaneous tracheostomy for several reasons in people with a critical illness who require long-term mechanical ventilation or airway management. This procedure may also benefit those with certain medical conditions, such as sleep apnea.

Still, in some cases, a doctor may recommend surgical tracheostomy procedures over this technique. Some benefits of percutaneous tracheostomy include the below.

Not needing to transfer to an operating room

People who require percutaneous tracheostomy typically already have severe illness, so reducing the need to go to an operating room for a procedure is beneficial. This may also have some cost-saving benefits.

Shorter procedure

The procedure for a percutaneous tracheostomy takes a shorter amount of time than other traditional methods such as surgical tracheostomy. Usually, the procedure itself takes 10 minutes.

Depending on the setting, set-up time can be up to 30 minutes, including the time it takes to prep, drape, and get the equipment ready.

Risks

With percutaneous tracheostomy, there is less risk of wound infection and post-procedure problems than with surgical tracheostomy. These reasons and many others could mean this procedure may be more suitable for patients at greater risk of health complications.

There are various techniques and kits available for performing percutaneous tracheostomy. A healthcare professional will decide on which technique to use.

Doctors will make a small opening in the windpipe with a large needle and use dilators to widen it until it is large enough to accommodate the tracheostomy tube.

The procedure varies from surgical tracheostomy, which relies on direct visualization of the trachea.

Different sizes of tracheostomy tubes exist — the doctor will advise on the right size tube on an individual basis.

The percutaneous tracheostomy procedure depends on the type of technique, but it typically involves the following steps:

1. The healthcare team positions the individual appropriately. They then cleanse and drape the area, which usually includes the front of the neck.
2. The team administers local anesthesia to numb the puncture site, a short-acting paralytic agent to prevent coughing, and sedation to ensure comfort during the procedure.
3. The doctor identifies the appropriate spot on the neck and uses a needle to enter the trachea.
4. They then thread a catheter and guidewire into the trachea and dilate the initial access site using a dilator.
5. They insert the deflated and lubricated tracheostomy tube into the airway and remove the dilator, catheter, and wire.
6. They then inflate the cuff of the tracheostomy tube and check the position by connecting it to a ventilator, assessing for gas exchange.
7. Once they confirm the position, they secure the tube to the person’s neck using ties or a securing device.

Where is the percutaneous tracheostomy positioned?

The exact position of the tracheostomy opening depends on anatomical landmarks and may vary slightly according to the individual.

The doctor creates the opening on the midline of the neck, below the level of the cricoid cartilage and above the sternal notch, which is the central dip between the collarbones.

It usually is between the second and third tracheal rings, which form the structure of the trachea, or windpipe.

However, it may be difficult to have that exact positioning since the airway is not viewable.

Percutaneous tracheostomy, although minimally invasive, may still cause complications.

These may include:

• bleeding
• infection
• loss of airway
• damage to surrounding structures
• tube dislodgement
• airway complications
• voice and swallowing problems
• fistula, which is a hole between the wind and food pipes
• a risk of ending up in the wrong location
• higher risk of a microfracture to tracheal tissue, leading to a condition called subglottic stenosis, which is the narrowing of the airways

The occurrence and severity of complications can vary. However, the healthcare team takes appropriate measures to prevent, monitor, and manage these potential risks and ensure the individual’s well-being.

Percutaneous and surgical tracheostomies are two different methods of creating an opening in the trachea. Here is a comparison:

• Procedure: A percutaneous tracheostomy involves inserting a tube into the trachea through a small incision in the neck. Surgical tracheostomy involves making a larger incision in the neck and accessing the trachea directly.
• Technique: Percutaneous tracheostomy is a bedside procedure that requires only local anesthesia and sedation. Surgical tracheostomy requires an operating room and requires general anesthesia.
• Benefits: Percutaneous tracheostomy is less invasive and faster to perform than surgical tracheostomy. It may be suitable for patients who have critical illness or in the ICU. However, surgical tracheostomy allows a more controlled and direct approach, allowing better visualization and access to the trachea.
• Timing: Doctors often perform percutaneous tracheostomy earlier in the treatment course, while surgical tracheostomy may be more suitable for when the person’s condition requires a more meticulous and precise approach.

There may be variations among hospitals about the indications for these procedures. For example, some prefer surgical tracheostomy procedures over percutaneous tracheostomy. Some hospitals may even perform a surgical tracheostomy bedside in the ICU as an option.

A percutaneous tracheostomy is a procedure that doctors use to create an alternative airway in individuals with breathing difficulties.

While percutaneous tracheostomy is less invasive and faster than surgical tracheostomy, it still carries some risks.

Some possible complications associated with percutaneous tracheostomy include bleeding, infection, tube-related issues, and damage to surrounding structures.

These issues can vary in severity and require prompt attention and appropriate management to ensure the best outcomes.