Experimental model for percutaneous tracheostomy training (original) (raw)
Related papers
A New Personal Percutaneous Tracheostomy Approach: A Preliminary Animal Study
The Internet Journal of Anesthesiology, 2008
Objectives: Percutaneous tracheostomy has been widely adopted for long-term airway management of critically ill patients. Currently, five different techniques are used; and the first two proposed, the original Ciaglia method and the Griggs forceps are still widely used. The aim of the study was to evaluate a new tracheotomy device and to determine possible advantages and complications. Methods: Six male farm pigs weighing 25-35 Kg were used for this study. The experiments have been conducted in accordance with national and international Laws and policies. The animals were anesthetized and percutaneously tracheotomized with the kit Mini Invasive Tracheostomy (kitMIT; X-med; Modena, Italy). One hour after the procedure, pigs were sacrificed and the trachea was checked for lesions. We evaluated the length of procedure, the difficulties in performing the procedure (Frova and Quintel classification), bleeding during the procedure, posterior tracheal wall damage, kinking of guidewire, tracheal rings fracture, and para-tracheal insertion. Results: Mean time of procedure was 8.24 minutes. There were some difficulties in performing two procedures. Bleeding was absent in 4 pigs, and minimal in 2 pigs. There were no cases of posterior tracheal wall damage, no cases of tracheal rings fracture, and no cases of para-tracheal insertion of the device. In 2 cases, we observed kinking of the guide-wire. Conclusions: In this experimental study, the kitMIT allowed safe and easy percutaneous tracheostomies. The next experimental step will be a perspective human study. DISCLOSURE Emilpaolo Manno has a financial interest in Mini Invasive Tracheostomy kit.
Interactive cardiovascular and thoracic surgery, 2015
As airway management specialists, thoracic surgeons should be familiar with percutaneous dilatational tracheostomy. To optimize the learning curve, we propose a home-made pig model obtained from a slaughterhouse for training residents in the technical aspects of performing percutaneous dilatational tracheostomy. The satisfaction of the residents' training experience using this model was compared with that using a standard manikin model. Fifty residents participated in the present study. At the end of the session, each participant completed a questionnaire assessing the pig model and the manikin by assigning a score (ranging from 1 to 4) to five specific characteristics including (i) reality of skin turgor; (ii) landmark recognition; (iii) feasibility of the procedure; (iv) reality of the model and (v) preference of each model. The differences between models were statistically analysed. Forty-five participants completed the study. The pig model, compared with the manikin model, p...
Our Experience with Percutaneous Tracheostomy at A Tertiary Care Centre
Introduction: Percutaneous tracheostomy (PCT) has become popular all over the world during the past two decades. Our aim was to record the learning curve, safety and complications of percutaneous tracheostomy, when introduced in a teaching hospital and also compare it with the conventional open procedure. We also analyzed the various parameters which can possibly influence the incidence of complications. Material and Methods: 36 patients underwent tracheostomy; 12 in open tracheostomy group, 24 in the percutaneous tracheostomy group which further consisted of 12 patients each in Ciaglia and Griggs methods of tracheostomy. Results: There were 17 (8 major and 9 minor) complications in the percutaneous tracheostomy group and one in the open tracheostomy group. In the percutaneous tracheostomy group, Ciaglia single staged dilatation technique was faster than the Griggs technique. In our study, complications were significantly related to neck girth but not to thyroid notch to suprasternal notch distance, age, sex, place of procedure and technique of procedure. Conclusion: Percutaneous tracheostomy has a steep learning curve in a teaching institution. However, if continually performed, the percutaneous tracheostomy is a safe and rapid alternative to surgical tracheostomy.
Safety, efficiency, and cost-effectiveness of a multidisciplinary percutaneous tracheostomy program*
Critical Care Medicine, 2012
The frequency of bedside percutaneous tracheostomies is increasing in intensive care medicine, and both safety and efficiency of care are critical elements in continuing success of this procedure. Prioritizing patient safety, a tracheostomy team was created at our institution to provide bedside expertise in surgery, anesthesiology, respiratory, and technical support. This study was performed to evaluate the metrics of patient outcome, efficiency of care, and cost-benefit analysis of the multidisciplinary Johns Hopkins Percutaneous Tracheostomy Program. Design: A review was performed for patients who received tracheostomies in 2004, the year before the Johns Hopkins Percutaneous Tracheostomy Program was established, and those who received tracheostomies in 2008, the year following the program's establishment. Comparative outcomes were evaluated, including the efficiency of procedure and intensive care unit length of stay, complication rate including bleeding, hypoxia, loss of airway, and a financial cost-benefit analysis. Setting: Single-center, major university hospital. Patients: The sample consisted of 363 patients who received a tracheostomy in the years 2004 and 2008. Measurements and Main Results: The number of percutaneous procedures increased from 59 of 126 tracheostomy patients in 2004, to 183 of 237 in 2008. There were significant decreases in the prevalence of procedural complications, particularly in the realm of airway injuries and physiologic disturbances. regarding efficiency, the structured program reduced the time to tracheostomy and overall procedural time. The intensive care unit length of stay in nonpulmonary patients and improvement in intensive care unit and operating room back-fill efficiency contributed to an overall institutional financial benefit. Conclusions: An institutionally subsidized, multidisciplinary percutaneous tracheostomy program can improve the quality of care in a cost-effective manner by decreasing the incidence of tracheostomy complications and improving both the time to tracheostomy, duration of procedure, and postprocedural intensive care unit stay.
Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up*
Critical care …, 2006
Abstract Objective: To compare the safety, availability, and long-term sequelae of percutaneous vs. surgical tracheostomy. Design: Prospective, randomized, controlled study. Setting: Combined medical/surgical intensive care unit in a tertiary referral hospital. Patients: Two hundred critically ill mechanically ventilated patients who required tracheostomy. Interventions: Tracheostomy by either percutaneous tracheostomy or surgical tracheostomy performed in the intensive care unit. Measurements and Main Results: The primary outcome measure was the aggregate incidence of predefined moderate or severe complications. The secondary outcome measures were the incidence of each of the components of the primary outcome. Long-term follow-up included clinical assessment, flow volume loops, and bronchoscopy. Both groups were well matched for age, gender, admission Acute Physiology and Chronic Health Evaluation II score, period of endotracheal intubation, reason for intubation, and admission diagnosis. There was no statistical difference between groups for the primary outcome. Bleeding requiring surgical intervention occurred in three percutaneous tracheostomy patients and in no surgical tracheostomy patient (p = .2). Postoperative infection (p = .044) and cosmetic sequelae (p = .08) were more common in surgical tracheostomy patients. There was a shorter delay from randomization to percutaneous tracheostomy vs. surgical tracheostomy (p = .006). Long-term follow-up revealed no complications in either group. Conclusions: Both percutaneous tracheostomies and surgical tracheostomies can be safely performed at the bedside by experienced, skilled practitioners.
Use of Simulation for Tracheostomy Care, a Low Volume, High Risk Nursing Procedure
2018
Use of Simulation for Tracheostomy Care, a Low Volume, High Risk Nursing Procedure by Vijaya Ramakrishnan MS Nursing, Towson University, 2010 BS Nursing, Rajkumari Amrit Kaur College of Nursing, 1982 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University March 2018 Abstract Often, education regarding low volume and high-risk procedures, like tracheostomy, are ignored. Lack of experience, skills, and human resources can lead to decreases in confidence levels, diminished quality of care, and potentially an adverse event. The purpose of this DNP project was to prepare simulation-based education on the tracheostomy procedure and provide hands-on education to bedside nurses. The projectOften, education regarding low volume and high-risk procedures, like tracheostomy, are ignored. Lack of experience, skills, and human resources can lead to decreases in confidence levels, diminished quality of care, and potentially an adv...
World journal of …, 2000
Percutaneous dilatational tracheostomy (PDT) is being increasingly used. Concerns have been raised as to its safety, especially when it is done at the bedside. A prospective evaluation was conducted of 100 consecutive, unselected critically ill patients with PDT. The mean intensive care unit (ICU) stay before PDT was 12 days. One surgeon performed PDT alone (5 cases) or assisted residents (95 cases) in all operations; 84 were performed at the ICU bedside. Only the first six patients were taken to the operating room solely for tracheostomy. A modified technique was used: (1) the endotracheal tube was left in place during sequential dilations; (2) dilators were inserted in a 60-degree cephalad orientation to the skin and directed caudally after penetration of the anterior tracheal wall;