A controversy that still exists is whether or whether not to perform a routine CXR post UN-COMPLICATED per Trache.
It is my practice not to, IF the procedure was straightforward (Done under direct bronchoscope guidance). Granted, if there are issues like difficulty gaining access to the trachea with multiple passes, desaturation or difficulty ventilating during, I will get the radiographers up.
My colleagues state that they all perform one as a routine to exclude pneumothoraces, false tracts etc…but it is my argument that under straightforward direct vision, the yield on CXR will be nigh on zero. But…in their defence, it is easy to do and I guess has a low radiation dose, but soon cumulates on the sick irradiated ICU patient!
See these surveys and abstracts and please comment….
Survey done from Birmingham into generic practice
Nice canadian article on traches
I think the important point is what is currently expected of us as consultants working in the UK. That is what we will be judged against should any complication from any procedure arise.
The consensus should come from our specialist organisation (the Intensive Care Society) rather than individual opinion or an opinion from another country. What is the ICS current guideline?
Also it is not always easy to define what is an uncomplicated procedure. Pneumothoraces may take some time to develop. Complications are sometimes discovered only after the person performing the procedure has left the building. Also as we well know, a hospital will do whatever is in their own best interests and this is not always supporting their staff against external criticism. It would be safest to continue to follow our own national guidelines and not put ourselves or those we are training at unnecessary risk.
Rae E Webster, Consultant in Intensive Care and Anaesthesia. MBChB FRCA FFICM LLB (Hons) MBA