PERCUTANEOUS TRACHEOSTOMY

STANDARDS:
* Procedure to be performed by Intensivist with Anaesthetist in attendance. Procedure to be preformed in Intensive Care Setting with Haemodynamic monitoring and Respiratory Support equipment in place. Emergency Crash Cart should be present at bedside.
* Nurse present during procedure to set up and maintain sterile field, assist with procedure and ensure working order of Fibreoptic scope ( F.O. scope).
* The nurse will set up and maintain a working sterile field for the Intensivist to preform procedure form.
* The nurse will assure that the Fibreoptic scope equipment as been properly prepared by the Theatre staff prior to procedure starting.
* The nurse will ensure working order of all bedside equipment prior to commencement of procedure.
* The procedure will be performed under the strictest aseptic conditions.
* The procedure will be explained to the patient (where applicable, or patients family) and written consent will be obtained by the medical officer.
* Universal precautions will be maintained throughout the procedure and in the clean up phase post procedure.
* Patient safety will be maintained throughout the procedure.

OUTCOMES:
* The risk of infection will be minimised through maintaining a sterile field for Intensivist to work in.
* The patient will maintain adequate O2 saturation and haemodynamics through observation of overhead monitors.

R : 23.1
EQUIPMENT: Ciaglia Set Hi Lo Trachea Tube, 7 or 8, usually 8
Eye protection Extra Lubrication
1% Lignocaine with Adrenalin. Syringes, 10 ml and 5 ml.
Needles, Size 19, 25, and 26. Clean suction bottle and tubing
Fibreoptic Scope Fenestrated Drape
Large Drape Dressing Pack
Masks Stainless steel trolley
Hexidine Solution
Gown and sterile gloves (size at request of Intensivist)
Sedation and paralytic agent as ordered by the Intensivist

PROCEDURE:
* Request Fibreoptic Scope from Theatre at least 20 minutes prior to procedure to give Theatre staff time to clean.
* Upon arrival, ensure Fiberoptic Scope is in working condition by testing light source.
* Fiberoptic Scope should be at head of bed within easy reach of Anaesthetist.
* Ensure suctioning equipment is set ups and ready to use at head of patient's bed, i.e. second suction bottle and rubbing for use with Fiberoptic Scope, Yankeur attached to first suction bottle for oral use, equipment for trachea suctioning and Ambu bag attached to O2 wall outlet.
* Set up stainless steel trolley with opened large sterile drape. Lay the following equipment out on drape using sterile procedure: dressing pack, fenestrated drape, needles size 19, 25 & 26, syringes 10ml & 5ml, cicylia set and sterile gloves.
* Within reach but not on sterile drape 1% Lignocaine with Adrenalin, masks, Hexidine solution, extra lubrication, Hi Lo trachea tube size 7 or 8 (usually 8) and eye protection.
* Patient should be paralysed and sedated prior to procedure. Sedation and paralytic agent to be ordered by Intensivist and given by nurse prior to procedure. Patient should be well medicated before commencement of procedure.
* Patient placed on back with neck fully extended.
R : 23.2 * Assist Intensivist to gown post surgical scrub by having sterile gown package open to expose sterile towel and tying up back of gown.
* During procedure assist Intensivist with drawing up solutions and placing appropriate solutions (maintaining sterile field) into dressing pack.
* Rinse Fiberoptic Scope with normal saline post procedure.

POST PROCEDURE:
* Check to see if ventilator settings are as ordered by Intensivist.
* Observe site for bleeding and change dressing around trache accordingly.
* If bleeding is excessive inform Intensivist.
* Observe for surgical emphysema and Pneumothorax which are potential complications.

Reviewed September 1995

R : 23.3

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