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Figure 5 | Critical Care

Figure 5

From: Traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trial

Figure 5

Risk associated with lateral tracheal puncture. Downward force (dashed black arrow) applied during dilation of the tract can be broken up into force vectors which are perpendicular (blue arrow) and parallel (red arrow) to the tracheal wall (black line). At a 90° angle, all of the force is perpendicular. With the angle becoming more oblique, hitting the lateral curve of the tracheal wall, there is an increasing proportion of the downward force which is parallel to the wall and a decreasing proportion directed towards the tracheal lumen. This can lead to bending of the guidewire and subsequent paratracheal tract dilation or tearing of the tracheal wall itself.

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Critical Care

ISSN: 1364-8535