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Percutaneous Tracheostomy Complications — FRCA Final MCQ

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ModerateAirway ManagementPercutaneous Tracheostomy ComplicationsFRCA Final

A 72-year-old woman (ASA III) undergoes an emergency laparotomy. The surgeon inadvertently creates a large diaphragmatic injury during the procedure, which is repaired. Post-operatively in ICU she requires prolonged ventilation. She is on day 14 and a percutaneous tracheostomy is planned. What anatomical structure is at greatest risk of injury during percutaneous dilational tracheostomy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Vertebral artery

During percutaneous dilational tracheostomy (PDT), the structures at risk include: the anterior jugular veins, thyroid isthmus and its vasculature (most commonly injured), the posterior tracheal wall and oesophagus (from the dilator or tube passing posteriorly), and rarely the innominate artery (from erosion with a low placement). Pre-procedural ultrasound to identify vascular structures and the thyroid isthmus, combined with fibreoptic bronchoscope guidance through the ETT, significantly reduces complications.

Reference: NTSP/DAS/ICS – 2023 – Tracheostomy guidelines; NCEPOD – 2014 – On the right trach?