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Table 3 HTA for BPDT

From: Human reliability analysis of bronchoscope-assisted percutaneous dilatational tracheostomy: implications for simulation-based education

 

Task

Plan

1

Perform pre-procedural safety and documentation checks

All team members perform 1-2

1.1

Perform hand hygiene

 

1.2

Perform “sign in”

 

2

Prepare for procedure

All team members to perform 1; perform 2–4 concurrently; appropriate team members to perform 5-7 in order.

2.1

Perform hand hygiene ± surgical scrub as appropriate

 

2.2

Prepare drugs and IV fluids for procedure

Airway operator

2.3

Prepare equipment

Team to prepare equipment related to individual role

2.4

Use percutaneous tracheostomy equipment checklist

All team

2.5

2.5.1

2.5.2

2.5.3

2.5.4

2.5.5

2.5.6

2.5.7

Prepare patient

Increase Fi02 to 1.0 (100%)

Optimise ventilation

Anaesthetist patient for the procedure

Tape eyes

Suction oropharynx under direct vision

Position patient for procedure

US examination of neck

Airway operator perform 1-5

All team members perform 6

Airway US trained team member

2.6

2.6.1

2.6.2

2.6.3

2.6.4

2.6.5

2.6.6

2.6.7

Bronchoscopic preparation of airway

Switch to catheter mount with bronchoscopic port

Insert bronchoscope into trachea

Suction any secretions from airway

Confirm anatomy

Orientate team to anatomy

Withdraw ETT under bronchoscopic guidance until cuff is at/just below the level of vocal cords

Confirm ability to ventilate

Airway operator and bronchoscope operator perform

2.7

Perform “time out”

All team

3

Perform bronchoscope-assisted percutaneous dilatational tracheostomy

Perform in order 1-11. Perform in order 12–17 if 02 sats > 90%; if < 90% perform 13; followed by 12-17

3.1

Clean skin with chlorhexidine cleaning solution × 2

 

3.2

Apply sterile fenestrated drape to front of neck

3.3

Choose tracheostomy insertion site

3.4

Infiltrate overlying skin with local anaesthetic

3.5

Use seeker needle to find the tracheal midline at tracheal ring 2–3a

 

3.6

Make a 1–1.5 cm horizontal skin incision at this level

3.7

Insert introducer cannula into tracheaa

3.8

Advance guide-wire into trachea and remove plastic cannulaa

3.9

Use mini-dilator to create tracta

3.10

Use rhino-dilator and atraumatic introducer to dilate tracta

3.11

Insert tracheostomy and inflate cuffa

3.12

Perform bronchoscopy through tracheostomy to confirm position

 

3.13

Attach ventilator to tracheostomy and confirm ventilation

 

3.14

Secure tracheostomy: suture to skin and apply tracheostomy tube tie

 

3.15

Remove ETT from airway

 

3.16

Confirm tracheostomy cuff pressure is within acceptable limits

 

3.17

Re-position patient

 

4

Perform follow-up care

All team perform in order 1–3, PT operator to perform 4–5 in any order

4.1

Perform hand hygiene

 

4.2

Confirm vital signs remain stable

 

4.3

Perform “sign out”

 

4.4

CXR to out-rule complications and confirm tracheostomy position

 

4.5

Perform post-procedural documentation

 
  1. a Interventions carried out under bronchoscopic guidance