Problemy techniczne podczas przezkrtaniowej tracheotomii przezskórnej – opis przypadku

Dariusz Maciejewski, Maciej Sawczuk, Rafał Kraus

Summary
Background. The Fantoni translaryngeal tracheotomy (TLT) includes retrograde dilatation of the trachea using a special device inserted through the larynx, which acts both as a dilating device and guidewire for the tracheostomy tube. When performed by a skilled operator, this procedure is atraumatic, does not require strength and lasts about 15-20 min., Lack of experience may however, result in unexpected complications. Case report. We describe a case of TLT performed by a trainee, who broke the obturator stick that is designed to reverse the tracheostomy tube in the trachea, from its initial cephalad to a caudal direction. The probable cause of this complication was the inadequate extraction (to the app. 3.5 cm mark) of the tracheostomy tube after it was pulled out of the trachea. The broken part of the obturator was removed using a teflon guidewire. The procedure was continued with another obturator without any further complications, after withdrawal of the tracheostomy tube to the level of the 2 cm mark. Discussion. To prevent such complications the following rules should be observed: the distance between the trachea and skin should be precisely evaluated; the whole procedure should be performed using fiberoptic bronchoscopy; and the trachea should be punctured by a calibrated guide needle. Additionally, the whole procedure should be practised on a manikin before any human procedure is attempted. The obturator should also be manufactured in such way that it cannot be broken, even in the described situation. The user should carefully read the instructions provided.

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