ATTENTION: Injury of the posterior wall of the tra-
c
hea must be avoided at all costs (bronchoscopic
c
ontrol). In addition care must be taken that the cuff
of the endotracheal tube is not pierced with the
puncture cannula.
5
. When air can be aspirated freely, the puncture
cannula is withdrawn from the Teflon catheter and
the catheter is pushed forward several millimetres in
a posterior and caudal direction (see Fig. 7). Then
air should be once again aspirated out of the tra-
c
hea with the syringe in order to check the position
of the catheter tip.
6. Then the guide wire is taken out of its sheath
(approx. 8 cm) until the J-shaped tip is located in the
straight inserter.
7. Then the inserter is put on to the Teflon catheter
and the guide wire carefully pushed through the
Teflon catheter up to its first marking (approx. 10 cm)
into the trachea (see Fig. 8). It should be possible to
easily push the guide wire forward and move it freely
in the catheter. If this manoeuvre causes the guide
wire to kink, then it must be replaced by an undam-
aged one. With the help of the bronchoscope it is
possible to check that the guide wire is being pushed
in a caudal direction. Then, the Teflon catheter can be
completely pulled out over the guide wire, whereby
the guide wire remains in its position in the trachea.
8. The short dilator (14 CH/FR) is inserted over the
guide wire into the trachea and the puncture site
dilated with slight rotations (see Fig. 9). Care must
be taken to ensure that the dilator is not out of align-
ment with the guide wire (to avoid damaging the
tip) and that it is introduced in a way that does not
damage the posterior wall of the trachea (broncho-
scope). Then the dilator is removed. In so doing the
position of the guide wire should remain unchanged.
9. The guiding catheter from the dilation set is
pushed forward with the side of the safety stop (in
the direction of the arrow) along the guide wire as far
into the trachea until the safety stop on the guiding
catheter reaches skin level (see Fig. 10). The proxi-
mal marking of the guide wire should at the same
time be at the proximal end of the guiding catheter.
4.3.2 Single-Step Dilation
1. To activate the lubrication coating of the experc
dilator, the narrow end of the dilator is immersed
immediately prior to dilation in sterile saline solution
or water up to the “MAXIMUM INSERTION” mark.
2. The experc dilator is pushed forward with its dis-
tal tip initially as far as the safety stop and over the
guiding catheter. In order to stretch the puncture
c
hannel, the dilator together with the guiding cathe-
t
er are carefully pushed forwards and backwards
into the trachea until the opening is somewhat big-
ger than the external diameter of the selected tra-
cheostomy tube (see Fig. 11). For purposes of ori-
e
ntation, there are markings at 38 CH/FR and 41
CH/FR (“MAXIMUM INSERTION”) on the dilator.
During dilation care should be taken that the position
of the guiding catheter and guide wire remain con-
stant in relation to the dilator.
WARNING: It is recommended not to insert the dila-
tor deeper than the “MAXIMUM INSERTION" mark
(skin level). Otherwise it can cause damage to the
trachea and/or carina. Rotational movements should
be avoided during insertion of the dilator. Likewise,
trauma to the tracheal rings should be avoided at
all costs.
4.3.3 Removing the Dilator
ATTENTION: Please pay attention to the differ-
ences between the sets with the TRACOE
®
twist
tubes and those with the TRACOE
®
twist plus and
TRACOE
®
vario tubes!
With TRACOE
®
twist Tubes:
The experc dilator is removed and the guiding
catheter remains with the Seldinger guide wire in
situ. Care should be taken that the safety stop of the
guiding catheter is situated at skin level, as is the
case before dilation, and the proximal marking of the
guide wire can be immediately recognised outside
the guiding catheter (see Fig. 12).
For TRACOE
®
twist plus and/or TRACOE
®
vario Tubes:
The dilator and the guiding catheter are removed
either one after the other or together at the same
time. The Seldinger guide wire remains in the patient
(see Fig. 12).
4.3.4 Inserting the Tracheostomy Tube
1. The collapsible silicone sleeve and the tracheo-
stomy tube are made to slide easily with the help of
a lubricant.
ATTENTION: Please be aware of the differences
between the sets with TRACOE
®
twist tubes and
those with TRACOE
®
twist plus/TRACOE
®
vario
tubes.
2a. With TRACOE
®
twist Tubes:
The atraumatic inserter located in the tracheostomy
tube is pushed over the guiding catheter as far as
the safety stop. The unit composed of guiding cathe-
ter and atraumatic inserter with tube is then intro-
9
TRACOE percutan
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