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Table 1 Proposed checklist before percutaneous dilatational tracheostomy (pre and post)

From: Checklist for percutaneous tracheostomy in critical care

  Yes No
Preption   
Confirm patient’s consent or next of kin’s assent   
Is the neck anatomy favourable (no previous surgery or radiotherapy?)   
Ultrasound of the neck performed? (Midline/abnormal vessels absent?)   
FiO2 requirement <70 %, PEEP <10 mm Hg   
Is coagulation okay? (Platelets >80,000/μl, INR <1.5, APTT <45 seconds)   
Anticoagulants and antiplatelets withheld?   
Gastric feeding suspended?   
Procedure   
Airway management and anaesthesia: Dr ……………………………………………………   
Tracheostomy: Dr…………………………………………………………   
Minimum monitoring (ECG/SpO2/NIBP/EtCO2)   
Airway rescue equipment available?   
General anaesthesia (propofol + opioid) and plysis (atracurium)   
20 ml local anaesthesia – 1 % lignocaine with adrenaline   
Ciaglia dilatational tracheostomy (preferably with subglottic suction). A range of tube sizes and adjustable flange tube should be available   
Airway toilet/suction and bronchoscopy   
Tracheostomy position is confirmed by EtCO2 and bronchoscopy   
Tracheostomy is secured with sutures and tapes, and inner cannula inserted   
Post procedure   
Check chest X-ray satisfactory?   
Document in the clinical record   
Review sedation and ventilation   
  1. APTT, activated partial pressure thromboplastin time; ECG, electrocardiogram; EtCO2, level of carbon dioxide released at the end of expiration; FiO2, fraction of inspired oxygen; INR, international normalised ratio; NIBP, non-invasive blood pressure; PEEP, positive end-expiratory pressure; SpO2, blood oxygen saturation.