To devise a novel technique and kit for percutaneous tracheotomies that could be an alternative to the current dilatational methods.
Four pigs were used for the development of this procedure. A 17G needle was used to puncture the trachea without incision or dissection. A customized guide wire was placed and the needle removed. A 1.25 cm incision of the skin was made on both sides of the wire in a longitudinal direction followed by the passage and placement of a 12 fr. peel-away introducer into the trachea. Then a 16mm x 50mm balloon dilatation catheter (Boston Sci.; VA) was loaded with an 8.0 Shiley tracheostomy tube (Nellcor; Pleasanton, CA) and placed one centimeter into the trachea and the introducer was peeled away. The balloon was subsequently inflated with normal saline to 5 torr for 3–5 seconds using an Encore® 26 Advantage Kit inflation device (Boston Sci; VA) to dilate the subcutaneous and tracheal tissues. Shiley tube was placed and the balloon was deflated and removed leaving only the tracheostomy tube in place.
A total of 4 pigs underwent percutaneous tracheostomy tube placement by balloon dilatation over guide wire. The mean procedure time was 8.5 minutes from tracheal puncture to ventilation with the tracheostomy tube. No unexpected adverse events occurred. No apparent damage was done to surrounding structures.
The balloon dilation technique for percutaneous tracheostomy differs by eliminating the need for dissection and removing the need for forceful dilatation of the peri-tracheal structures. Midline puncture of the trachea is imperative for a successful outcome. Human trials are pending.
We propose that this novel technique of percutaneous tracheostomy tube placement can save time and potentially decrease complications when applied to humans.
M. Zgoda, Pending FDA investigational device approval, Self.