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Ciaglia technique

Up Blocked tracheostomy Ciaglia technique Tracheostomy tubes


  • 2 major concerns: ET tube needs to be withdrawn above site of tracheostomy and procedure is "blind". Latter increases risk of paratracheal insertion of tracheostomy tube
  • risks of inappropriate positioning of ETT include balloon rupture, transfixation of ETT and loss of airway control
  • various methods have been used to ensure that ETT is above site of proposed tracheostomy while maintaining adequate ventilation:
    • withdraw ETT until just below cords, insert needle and rotate and oscillate ETT to ensure it is not impaled by needle
    • ballot ETT balloon to identify appropriate ETT position. Neither of these methods guarantee proper positioning
    • use of bronchoscope to check position and prevent paratracheal insertion. Ventilation may be difficult with the bronchoscope in position
    • ventilation through laryngeal mask
  • anatomic abnormalities, marked obesity, uncorrectable coagulopathies and children are relative contraindications although percutaneous dilational tracheostomy has been safely performed in all these groups
  • procedural and in situ complication rates are as low or lower for PDT than for surgical tracheostomy

Procedure


©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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