Percutaneous tracheostomy: a guide wire complication

Abstract

We report an unusual complication of percutaneous dilatational tracheostomy, in which the guide wire became lodged in the bronchial tree. The assistance of an expert bronchoscopist resulted in successful removal of a fractured J wire with no adverse sequelae for the patient. A subsequent incident has given insight into the mechanism of damage to the guide wire.

Percutaneous Dilatational Tracheostomy and Modifications in Intensive Care Unit Patients

“…Furthermore, the incidence of late complications was 8.6%, including: stomal infection, difficult replaces tracheostomy tube, tracheoesophageal fistula, tracheal stenosis, and tracheomalacia [7]. An unusual complication of percutaneous dilatational tracheostomy, was reported by Phukan DK 2004, in which the guide wire became lodged in the bronchial tree [9]. We didn't encounter this complication and we hope never.…”

How is sedation provided for percutaneous dilatational tracheostomy in English ICUs?

“…Up to 40% of patients in the ICU report some awareness whilst receiving neuromuscular receptor blocking drugs [ 1 ] - these drugs are usually employed when performing PDT. Depth of anaesthesia monitoring may prevent awareness and has been used during PDT [ 2 ]. Various depths of anaesthesia monitors are available, including the bispectral index monitor (BIS), the Narcotrend Index and the State and Response Entropy, derived from the EEG.…”