What does percutaneous transtracheal jet ventilation mean?
Percutaneous transtracheal jet ventilation is a procedure to insert a needle into the trachea and pump in high-pressure air to breathe for the patient. It avoids some problems of naso-tracheal intubation and is less invasive than a tracheostomy (surgical breathing hole in the throat).
Percutaneous transtracheal jet ventilation (PTJV) is a procedure to deliver oxygen to the lungs. Oxygen is delivered at a high pressure by inserting a thin flexible tube (catheter) through the skin (percutaneously) into the windpipe (trachea) using a high-pressure gas source.
The technique was introduced in the 1950s. By the early 1970s, it was successfully used for airway management during routine general surgical procedures lasting up to two hours. PTJV is specifically useful for life-threatening situations, such as sudden respiratory failure, where quick access to the airways by conventional techniques (such as tracheal intubation and bag-mask-valve ventilation) cannot be performed.
In such circumstances, PTJV with a wide (large-bore) needle gives quick oxygenation and ventilation by providing adequate gas exchange and ensuring the patency of the airway until a definitive procedure (e.g., oral intubation with bronchoscopy followed by surgically gaining access to the trachea) can be performed. The procedure requires fewer instruments and can be performed more quickly than the ones mentioned above.
PTJV is suitable in any situation where intubation (inserting a tube for breathing in the trachea) cannot be achieved or should be avoided. The procedure is typically helpful in the following cases:
- As a means of ventilation during surgery and procedures on the upper airway.
- PTJV can force aspirated secretions out of the upper part of the trachea (proximal trachea) and may force a foreign body out of the proximal trachea (in cases of partial airway obstruction).
- It is a fast means for obtaining airway control in both planned and emergency surgeries for patients of all ages and varied clinical situations.
- PTJV is the surgical airway of choice for children younger than 12 years because their small tracheal diameter makes intubation difficult.
What happens during percutaneous transtracheal jet ventilation?
During a PTJV procedure
- The doctor administers local anesthesia.
- Anesthetic medicine may be sprayed in the patient’s trachea to suppress the cough reflexes.
- The patient lies with the neck exposed. The head may be in a “sniffing” position (hyperextended) to make Adam’s apple prominent.
- The doctor feels the dip/notch just below Adam’s apple where the needle has to be inserted.
- A wide-bore needle attached to a syringe containing saline is inserted through the skin while exerting negative pressure on the barrel of the syringe.
- Air bubbles in the fluid-filled syringe indicate entry into the larynx (voice box).
- After entering the larynx, a thin tube (cannula) is advanced into the larynx and trachea and then the needle is removed.
- The doctor secures the cannula by suturing it to the skin or by placing a circumferential tie around the neck.
- An oxygen source is connected to the cannula.
- A trial of several bursts of oxygen flow is done to ensure that the cannula is correctly placed and the setup is ventilating the patient properly
What are the complications of percutaneous transtracheal jet ventilation?
The following complications may occur with PTJV:
- Aspiration (accidental entry of food or secretions into the trachea)
- Bleeding
- Pneumothorax (the presence of air or gas in the cavity between the lungs and the chest wall)
- Subcutaneous emphysema (air or gas under the skin)
- Injuries
- Catheter-related problems (e.g., obstruction or blockage of the catheter, kinking of the catheter, catheter displacement or misplaced or unsuccessful needle or catheter placement)
- Inadequate ventilation
- Infection