The accurate identification of the percutaneous tracheostomy insertion site using digital palpation in children

BACKGROUND: Percutaneous tracheostomy (PT) may be required frequently in long-term ventilated intensive care patients. Although the overall risks are low, serious complications may occur, especially in children. Hence, this study aimed to assess physician accuracy in identifying PT insertion sites by digital palpation in children aged between 5 and 13 years. METHODS: Participants were asked to identify the needle entry point (interspace between 2nd and 3rd or 3rd and 4th tracheal rings) for PT using digital palpation. Then, a single operator scanned the neck of each child with a linear high-frequency transducer. An accurate estimation was defined as a mark made between the upper and lower borders of the tracheal rings within the midline. RESULTS: In the study including 104 patients, the PT insertion site was accurately identified with digital palpation in a total of 50.9% of patients, compared with sonographic findings. The time required to determine the PT entry point by USG was longer than the palpation technique (114.7 vs. 43.8 s, P<0.001). The mean distance between the entry points of both methods was 4.53±2.03 mm. The majority of inaccurate assessments (45%) was above the 2nd tracheal ring. The lower the skin-to-air-mucosal interface distance, the higher the success of the PT entry point detection with the digital palpation method. A one-unit increase in body mass index was related to increasing the risk of failure by 1.1 times (P=0.030). CONCLUSION: Significant physician inaccuracy exists in PT insertion sites in children aged between 5 and 13 years, especially as BMI increases. Pre-procedural USG may help identify the landmarks for PT.