The technique of percutaneous tracheostomy. Using serial dilation to secure an airway with minimal risk

Percutaneous tracheostomy is the procedure of choice for most patients who require prolonged use of an artificial airway; it can be performed rapidly at the bedside and is associated with fewer complications than is the standard procedure. The serial dilational technique involves the insertion of prelubricated dilators that gradually enlarge the diameter of a tract made by a guidewire and guiding catheter, facilitating placement of a standard double-cannula tracheostomy tube. The most dangerous complication, paratracheal insertion, occurs only rarely. The small skin incision and resulting tight fit of the tracheostomy tube in the stoma help prevent bleeding and infection.