ABSTRACT : To assess complication rate, average time required and to review application in patients with difficult anatomy and coagulopathy.

METHODS : This audit included 30 patients who underwent PCT during a period of 6 months from April to September 2014. The data was derived from the tracheostomy log book of ICU and the patient’s case notes. We analyzed following parameters- diagnosis, indication of tracheostomy, age, sex, height, weight, platelet count, INR, crico-sternal distance, duration of procedure and immediate complications. Preprocedural USG neck was performed . PCT was performed by Grigg’s technique using Smith’s PCT set with Grigg’s guide wire dialator forceps. Every step was confirmed by fibreroptic bronchoscope.

RESULTS : Obese patients with BMI>30 were 3(10%). Short neck was present in 5(16.66%). INR was 1.3-1.5 in 4(13.33%) and platelet count was 80000-100000/cmm in 5 patients(16.66%). Minor complications like bleeding controlled with adrenaline soaked gauze, hypotension and endotracheal tube cuff perforation were present in 7 patients(23.3%). No major complications were noted. There was failure requiring conversion into open tracheostomy in 1 patient as trachea couldn’t be approached due to large thyroid. The time taken for PCT was 6-10minutes

CONCLUSIONS : Scenarios earlier perceived as contraindications like difficult anatomy and coagulopathy can be managed safely with PCT with the help of tools like USG and bronchoscope.