Name of the Procedure:

Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapy

• Common names: Transtracheal Oxygen Therapy (TTOT), Transtracheal Catheter Insertion
• Technical terms: Percutaneous Transtracheal Ventilation, Transtracheal Catheterization

Summary

Transtracheal oxygen therapy is a procedure where a thin tube is inserted directly into the trachea (windpipe) to deliver oxygen more effectively. This method provides a direct pathway for oxygen to reach the lungs, often used when traditional oxygen therapy methods are insufficient.

Purpose

• Medical condition/addressed: Chronic obstructive pulmonary disease (COPD), severe breathing disorders, and other forms of respiratory failure.
• Goals/expected outcomes: Improved oxygen delivery to the lungs, enhanced quality of life, reduced breathlessness, and possible reduction in the need for supplemental oxygen via nasal cannula or face mask.

Indications

• Chronic respiratory conditions (e.g., COPD)
• Hypoxemia unresponsive to other forms of oxygen therapy
• Patients experiencing discomfort or complications from nasal cannula or face mask oxygen delivery systems

Preparation

• Fasting for a specified period before the procedure
• Adjustments or temporary cessation of certain medications, as advised by the healthcare provider
• Diagnostic tests such as blood work, pulmonary function tests, or imaging studies to assess lung and airway status

Procedure Description

1. The patient is positioned, typically lying down, with the neck extended.
2. Local anesthesia is administered to numb the area around the trachea.
3. A small incision is made in the neck overlying the trachea.
4. A needle is inserted through the incision into the trachea.
5. A guidewire is passed through the needle into the trachea.
6. Using the guidewire, a series of dilators incrementally widen the tract to the trachea.
7. Finally, a stent or indwelling tube (catheter) is introduced over the guidewire into the trachea.
8. Once in place, the catheter is secured and connected to an oxygen supply.

• Tools, equipment, technology: Local anesthesia, scalpel, needle, guidewire, dilators, stent or catheter, oxygen tubing and supply
• Anesthesia or sedation: Local anesthesia is most commonly used

Duration

Typically, the procedure takes about 30 minutes to 1 hour.

Setting

The procedure is generally performed in a hospital setting, potentially in an outpatient clinic or surgical center equipped for respiratory procedures.

Personnel

• A specialized physician or surgeon (e.g., pulmonologist or otolaryngologist)
• Nurses
• Anesthesiologist or anesthetist (for managing local anesthesia)
• Respiratory therapist (possibly involved in post-procedure care)

Risks and Complications

• Common risks: Bleeding, infection, discomfort at the insertion site
• Rare risks: Damage to the trachea, pneumothorax (collapsed lung), dislodgment of the catheter
• Possible complications: Infection management with antibiotics, bleeding control

Benefits

• Improved oxygen delivery directly to the lungs
• Enhanced overall respiratory function
• Potential reduction in supplemental oxygen requirements
• Improved quality of life with decreased respiratory distress

Recovery

• Immediate post-procedure monitoring for any complications
• Maintenance of the catheter, including daily cleaning and periodic replacement
• Follow-up appointments to monitor the patient's respiratory status and catheter positioning
• Most patients can resume normal activities within a few days, with some care to avoid dislodging the catheter

Alternatives

• Other oxygen delivery methods such as nasal cannula, face masks, or non-invasive ventilation
• Pros: Non-invasive, easier to manage without surgical intervention
• Cons: Less efficient oxygen delivery, potential for discomfort and skin irritation

Patient Experience

• During the procedure: Possible discomfort or pressure despite local anesthesia; minimal pain
• After the procedure: Initial soreness at the insertion site; improved breathing as oxygen therapy becomes effective
• Pain management: Local anesthesia during the procedure; pain relievers post-procedure as needed; guidelines on catheter maintenance and comfort measures provided by the healthcare team.