Percutaneous and Surgical Tracheostomy: Consent and Patient Information

Many patients require a tracheostomy as part of their care during admission to JVF ICU or NCCU. The decision to perform a tracheostomy should be made jointly between the intensive care and parent teams.

Both the ENT surgeons and the intensive care teams may complete the consent process for a surgical tracheostomy. Only the intensive care team may complete the consent process for a percutaneous tracheostomy.

Never assume that a patient lacks capacity, the absence of capacity must be demonstrated. Once done so, the decision to perform the tracheostomy may be taken in the patient’s best interests and this should be documented on a NHS Consent Form 4 according to Trust policy.

When it is decided that a patient may require a tracheostomy the next of kin, or medical power of attorney, must be approached and a the procedure explained.

This patient information sheet should be provided and enough time allowed to to read the sheet and ask questions.

In the rare situation where a critically ill patient has capacity a similar process should be followed but a NHS Consent Form 1 should be completed following discussion with the patient.

It is essential that the following is clearly explained to the patient, relative, or medical power of attorney:

  • The reason why are tracheostomy is being inserted.
  • Which technique will be used, surgical or percutaneous, and why.
  • The timing of the tracheostomy.
  • The potential complications which should include: bleeding (0.5 – 2% and may require an operation), infection (less than 1%), and accidental decannulation, airway loss, and tube blockage (less than 1% but may be fatal). In addition pneumothorax, surgical emphysema should be explained but that the incidence is extremely uncommon, less than 1:1000.

Other complications are discussed in the patient information sheet. The consent process and the content of the discussion must be recorded in the patient’s notes.

Further Educational Resources

Life In The Fast Lane

British Journal of Anaesthesia (open access).

Anaesthesia – Safety and Complications of Percutaneous Tracheostomy (open access). 

International Journal of Critical Illness and Injury Science – Complications Associated with Surgical and Percutaneous Tracheostomy (open access). 

Laryngoscope – Complications of Surgical Tracheostomy (non-open access).