Percutaneous tracheostomy by guidewire dilating forceps technique: review of 98 patients.

BACKGROUND: Percutaneous tracheostomy to a large extent has replaced conventional surgical tracheostomy by virtue of its low incidence of complications and the rapidity with which the procedure can be performed at the bedside avoiding transport of critically ill patients to the operating rooms. Since it is a blind approach, bronchoscopic guidance has been suggested which might not always be possible due to logistic reasons.
METHODS: A retrospective study of 98 patients who had guide wire dilating forceps technique of percutaneous tracheostomy without the aid of a bronchoscope was undertaken. By ensuring the free mobility of the guide wire at each step of the procedure, a safe placement of the tracheostomy tube was achieved.
RESULTS: The mean operating time was 3.05 mins [S.D:2.20]. Two patients had peristomal bleeding as an early complication. 34 patients could be decannulated with good primary approximation of the stomal tissues [mean: 3.92days, S.D: 1.46]. There were no deaths or life threatening complications attributable to this technique.
CONCLUSIONS: In the absence of bronchoscopic guidance, adopting the simple but effective precaution of free movement of guide wire at each step of the procedure, a safe tracheostomy tube placement is possible.