A percutaneous tracheostomy is a procedure which is used to secure airway access in a patient. It is the less invasive of two methods which can be used to create a tracheostomy, a hole in the trachea which can be used to help a patient breathe. Such procedures may be performed to provide temporary relief or for the purpose of developing a permanently secured airway for the patient.
The tracheostomy is one of the oldest known surgical procedures. Texts dating back thousands of years document the practice of making holes in the throat and inserting tubes so that people can breathe when they are unable to do so through their mouths. Historically, this procedure was performed surgically, by cutting into the throat, dissecting down to reach the trachea, making a hole, and then inserting a tube, and this is still one option for the procedure which may be used in some cases.
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In a percutaneous tracheostomy, the surgeon inserts a needle into the trachea, follows it with a guidewire, and then inserts a catheter. The catheter is used to introduce dilators which are used to create a hole in the trachea which can accommodate a tracheostomy tube. Once in place, the tube is secured so that it will not fall out. The percutaneous tracheostomy is not an emergency procedure and it is usually performed on patients who are reasonably stable and sedated so that the surgeon can take the time to work slowly and carefully.
Although it is possible to perform a percutaneous tracheostomy without visual guidance, many surgeons prefer to use endoscopy cameras or mirrors so that they can see into the throat while they work. This ensures that they can place the needle properly and guide it through the throat with a minimum of damage for the patient. The length of time required for the procedure varies depending on the specifics of the patient's case.
When a doctor feels that a tracheostomy would be a good idea for a patient and that the patient is a good candidate for a percutaneous tracheostomy, this will be discussed with the patient or with the person who is making decisions on behalf of the patient. There are risks and benefits to the procedure which should be weighed before consenting. It is also advisable to get aftercare directions before the procedure so that people can be prepared for living with a tracheostomy before the procedure is performed. Some patients also find it helpful to speak with people who have had this procedure so that they can get the perspective of another patient.