- What is percutaneous dilation tracheostomy?
Percutaneous dilation tracheostomy (PDT) is a minimal invasive technique to create an access into the trachea for using a tracheostomy tube. PDT is mostly performed in intensive care units (ICU) for ventilated patients. Most commonly, this technique is performed bedside.The surgical tracheostoma is created for permanent and long-term patients, where a stable airway is necessary. The patient could breathe through the stoma without a tube due to its stability.
In contrast to a surgical tracheostoma, the percutaneous tracheostoma is used for ventilated patients who have a temporary opening and should be weaned afterwards.
However, in some countries operating room time is expensive, surgical techniques require more personnel and carry a number of different risks. These factors have led to an interest in developing a safe, convenient and cost-effective procedure that can be performed bedside.
- Different percutaneous tracheostomy techniques
**The first percutaneous dilation technique was based on the use of a range of separate dilators, each with a larger diameter, to gradually enlarge and dilate the tracheostoma (sequential dilator technique according to Ciaglia).
This technique has now been almost completely replaced by the faster and more convenient single step dilator, the so called Rhino-System.
**Another method used by Smiths medical is the “dilating forceps” technique developed by Griggs. Here the trachea is dilated by using a forceps device. This technique has a higher risk of bleeding and injuries.
**The “translaryngeal, retrograde” TLT technique according to Fantoni used by Covidien is a very complex from inside-out technique which requires lots of experience and has therefore not achieved widespread use.
**The “screw dilation” technique (PercuTwist), developed by Frova and Quintel for Rüsch Teleflex, creates the tracheostoma using a self-tapping screw dilator.
**The “balloon percutaneous tracheostomy” system from Cook (Blue Dolphin)according to Zgoda and Berger performs the dilation by using a balloon which is filled with saline. The fully deflated balloon is inserted into the pre-dilated opening and to build up the inflation pressure of up to 11 atmospheres a special pump is required. Immediately after the procedure the saline in the balloon is withdrawn and the whole assembly as a unit is pushed into the trachea to place the tracheostomy tube. The inserter with the attached balloon is then removed.
The Tracoe experc kit
The Tracoe experc kit is composed of two sterile and separately packed subsets (component) which come in one box:
The first component is the Tracoe dilation set which contains all items to perform the PDT according to the Ciaglia dilation technique:
Puncture needle with Teflon catheter
Seldinger guide wire made of kink resistant NiTiNol with inserter
Blue short dilator (14FR/CH)
White guiding catheter with safety stop
Green Tracoe experc dilator with hydrophilic coating
The second subset contains either a Tracoe twist, Tracoe twist plus orTracoe vario tracheostomy tube preloaded on an atraumatic insertion system with a no-step-sleeve (“P-Set”) for an easy insertion.
Tracoe twist P-Setpre-mounted on atraumaticinserter with no-step-sleeve
Tracoe twist plus P-Set pre-mounted on atraumatic insertion system with nostep sleeve
Tracoe vario P-Setpre-mounted on atraumatic insertion system with nostep- sleeve
Tracoe atraumatic insertion system:
Placing the tube into the tracheostoma is a challenge in percutaneous dilation tracheostomy due to the difference in diameter between the inserter and the tube.The Tracoe experc kits deliver an innovative solution in the form of the patented atraumatic insertion system. A soft silicone sleeve at the tip of the insertion instruments smoothly bridges the gap in diameter between the inserter and the tube.This minimises the risk of injury of the trachea and/or cartilages during the tube insertion. The soft silicone sleeve helps the tube be inserted safely.
|ill fitting =traumatic step|
Tube with Cook Blue Rhino inserter
Twist twist plus vario
|• TRACOE twist
• TRACOE twist plus
• TRACOE vario
|Optimized fit between tube and inserter
Safer and smoother insertion of the tracheostomy tube
Minimises the risk of tracheal and tissue injury