Percutaneous Tracheotomy Workup

  • Author: Scott E Brietzke, MD, MPH; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 16, 2011
 

Laboratory Studies

  • Complete blood count: Platelet count must be more than 50,000/µL.
  • Coagulation profile: Prothrombin time or activated partial thromboplastin time must be less than 1.5 times the reference range.
  • Bleeding time: Bleeding time should be checked if blood urea nitrogen is more than 40 mg/dL or if the creatinine level is above 4 mg/dL. Bleeding time must be less than 10 minutes.
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Imaging Studies

A standard chest radiograph can provide information regarding the tracheal air column. Anteroposterior filtered tracheal views and lateral soft tissue views of the neck provide information regarding the glottic and subglottic air columns.

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Contributor Information and Disclosures
Author

Scott E Brietzke, MD, MPH  Assistant Professor of Surgery, Uniformed Services University of the Health Sciences; Director, Pediatric Otolaryngology, Department of Surgery, Otolaryngology Service, Walter Reed Army Medical Center; Associate Program Director, National Capital Consortium Residency in Otolaryngology

Scott E Brietzke, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, and American Academy of Sleep Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Michael S Kong, MD  Resident Physician, Department of Otolaryngology, National Capital Consortium

Michael S Kong, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Medical Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Joshua S Schindler, MD  Assistant Professor, Department of Otolaryngology, Oregon Health and Science University

Joshua S Schindler, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Darius Bliznikas, MD  Staff Physician, Department of Otolaryngology, Wayne State University School of Medicine

Darius Bliznikas, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Soly Baredes, MD  Associate Professor of Clinical Surgery, Chief, Section of Otolaryngology-Head and Neck Surgery, Director, Division of Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Soly Baredes, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, American Society for Head and Neck Surgery, New York Academy of Medicine, New York Academy of Sciences, New York Head and Neck Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Lanny Garth Close, MD  Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons

Lanny Garth Close, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Laryngological Association, American Society for Head and Neck Surgery, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gregory C Allen, MD  Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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Guidewire dilator forceps (GWDF).
Rapitrach dilating forceps.
Percutaneous dilational tracheotomy (PDT technique). Needle access of airway after blunt dissection of pretracheal tissues.
Percutaneous dilational tracheotomy (PDT technique). After removing the needle and reaspirating to confirm catheter location in the airway, the guidewire is placed.
Percutaneous dilational tracheotomy (PDT technique). Serial dilations are performed over the guidewire.
Percutaneous dilational tracheotomy (PDT technique). A tracheotomy tube is inserted in the dilated passageway using a dilator as obturator over the guidewire.
Guidewire dilating forceps (GWDF) technique. The guidewire dilator forceps are advanced along the Seldinger wire into the long axis of the trachea.
Guidewire dilating forceps (GWDF) technique. The guidewire dilator forceps enlarge the hole between tracheal rings.
Table. Summary of comparative studies results
Complication Pooled OR 95% CI P value
Decannulation/obstruction2.791.29-6.030.009
False passage2.700.89-8.220.08
Minor hemorrhage1.090.61-1.970.77
Major hemorrhage0.600.28-1.260.17
Wound infection0.370.22-0.620.0002
Unfavorable scarring0.440.23-0.830.01
Subglottic stenosis0.590.27-1.290.19
Death0.700.24-2.010.50
Overall complications0.750.56-1.000.05
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