Definition & Overview
Oxygen therapy is a medical procedure used to provide oxygen support for patients who are unable to breathe properly on their own due to respiratory and medical conditions, such as pneumonia and severe chronic lung disease. There are several techniques used in oxygen therapy. One of them involves the use of a needle wire dilator/stent or tube that is inserted percutaneously into the trachea.
Transtracheal oxygen therapy, also known as TTO, has been widely used for over 30 years now. It is more efficient, safer, and is well-tolerated by most patients when compared to other available techniques.
Who Should Undergo and Expected Results
Transtracheal oxygen therapy is beneficial for patients who need oxygen support due to long-term or constant breathing problems, which can be caused by:
- Obstructive sleep apnoea
- Severe chronic lung disease
- Chronic obstructive pulmonary disease (COPD)
- Pneumonia with empyema
- Pleural effusion
Oxygen therapy works by supplying low-pressure oxygen at controlled volumes and pressures. This supplements patients’ normal atmospheric breathing. The oxygen is supplied either through a needle wire dilator/stent or through a tube that is implanted percutaneously in the trachea.
One alternative method is the use of a nasal cannula that delivers oxygen into the nose. However, this is known to cause irritation and soreness to the nose.
Another alternative method is the modified Seldinger technique. This involves creating a tracheocutaneous fistula. However, the tract created during the procedure takes 6 to 8 weeks to mature. This results in a long recovery period. Also, the procedure to create the fistula is labour-intensive.
Another oxygen supplementation method is the endotracheal intubation. This, however, is reserved for use only in emergency situations and only for a short period of time. This is not advisable for patients who require regular oxygen supplementation.
Thus, the transtracheal oxygen therapy is the preferred method for many. In summary, it offers a lot of advantages for the patient, including:
- Faster healing time
- Less labour-intensive procedure
- Reduced complications
The procedure can greatly improve patients’ quality of life. The constant supply of oxygen helps ensure they do not experience breathing difficulties anymore. It also means patients do not have to keep going back to their doctor for oxygen therapy.
How is the Procedure Performed?
Transtracheal oxygen therapy is performed by introducing either a needle wire dilator/stent or an indwelling tube into the trachea. The device is implanted percutaneously. The procedure is performed through the following steps:
- The patient is placed under local anaesthesia.
- The doctor then advances a hypodermic needle into the trachea.
- The guide wire is then inserted through the needle. The doctor continues by inserting a tissue dilator over the guide wire to enlarge the tract. The needle and the dilator are then removed.
- A stent is then inserted over the guide wire, which is then removed. The stent stays in place while the dilated tract heals.
- Once the tract heals, the stent is removed. The first catheter is then inserted and is kept in place until the healing process is complete. It is then connected to a supply of oxygen so that therapy can begin.
- If necessary, the first catheter is removed and replaced with a new one. In some cases, doctors use a second kit followed by a third kit. Subsequent catheters are removable so that the patient can remove them for cleaning.
For this procedure, doctors use a large 14-gauge cutting needle in the trachea. It is introduced at the point between the cricothyroid membrane and the sternal notch. This size needle can provide the patient with up to 3 litres of oxygen per minute at 2-psi pressure level. However, this is not always enough, as some patients may need higher flow rates.
Possible Risks and Complications
In a study performed on 24 paediatric patients, the insertion procedure was successful in 100% of the cases. The patients suffered from pneumothorax, haemothorax, pneumonia with empyema, chylothorax, and pleural transudate effusion. They were all given chest tubes inserted using the needle-wire-dilator technique. None of the patients suffered from any serious complications, except for a kink in the chest tube. This led to the recurrence of pneumothorax and pleural effusion in five of the patients. The complication was resolved by replacing the chest tubes with a stiffer type.
The study showed that the procedure is a safe and efficient method to provide oxygen therapy to patients suffering from a wide range of breathing problems and medical conditions.
Ahmed MY, Silver P, Nimkoff L, Sagy M. “The needle-wire-dilator technique for the insertion of chest tubes in pediatric patients.” Pediatr Emerg Care. 1995 Aug;11(4):252-4. http://www.ncbi.nlm.nih.gov/pubmed/8532576
- “Transtracheal catheter system and method.” https://www.google.ch/patents/US5186168