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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