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CRITICAL CARE AND TRAUMA

Twenty Months’ Routine Use of a New Percutaneous Tracheostomy Set Using Controlled Rotating Dilation

Intensive Care Unit, Harefield Hospital, Royal Brompton & Harefield Hospitals NHS Trust, Middlesex, UK

Address correspondence and reprint requests to Dr. Shane J. George, ICU, Harefield Hospital, Middlesex UB9 6JH, UK. Address email to shanegeorge{at}btinternet.com

After a favorable trial period, we introduced the new percutaneous tracheostomy set, PercuTwist^TM, in February of 2002 for our routine procedures. Over the next 20 mo, 90 procedures were performed with minimal complications. To prospectively evaluate this experience, we collected information on reasons for unit admission, operators’ previous experience, the duration of prior tracheal intubation, the time needed for the procedure, the grading of the difficulty, the amount of bleeding, and the complications of the procedure. Twenty-two of 90 (24.4%) procedures were performed by senior consultants with experience; 68 of 90 (75.6%) were safely performed by intensive care residents under close bedside supervision. The mean time needed for the procedure was 13 min 7 s. In only one procedure during the entire study was any difficulty observed during the insertion process. This occurred because the initial skin incision was too small. However, no major bleeding or complications were encountered.

IMPLICATIONS: Routine use of a controlled rotating dilation percutaneous tracheostomy technique can be safely performed over a long period by doctors with different levels of experience under close bedside supervision and represents a viable alternative percutaneous tracheostomy technique.

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