A Comparison of Three Endoscopes in Assessment of Tracheostomy Position in Simulation Manikins

R. Templeton, B. McGrath, K. Webster, W. Simpson South Manchester University Hospital Trust, Intensive Care Unit, Manchester, UK INTRODUCTION. Displacement of tracheostomy tubes causes significant patient harm. Fibreoptic endoscopy can assess the position of a tracheostomy tube within the trachea both in elective and emergency situations and can reduce the incidence of patient harm. Simulation manikins are a useful tool in developing the relevant skills. OBJECTIVES. To compare the time taken to achieve adequate views for assessment of tracheostomy position and the operator’s ease of endoscopy score with 3 different endoscopes in manikins. METHODS. Twenty five anaesthetic trainees assessed tracheostomy tube placement using the Ambu aScope2, Olympus LF-GP, and Olympus MAF. Observations were made using three training manikin variants: METIman (using both ‘standard’ and ‘difficult’ airway settings) and SimMan. Tube position was assessed via the tube lumen and within the trachea by both the oral and nasal routes. For each assessment of tracheostomy placement, the time taken to achieve satisfactory visualisation (determined by observer) was recorded. In addition, the trainee allocated an ‘ease of endoscopy score’with a score of ‘1’ indicating great difficulty and a score of ‘10’ indicating great ease. Data were analysed using Friedman test to compare the three endoscopes (observations were matched for trainee, route of visualisation, and manikin variant). RESULTS. 225 observations were made with each endoscope. Satisfactory visualisation was achieved in 120 s or less in over 99 % of observations and in 60 s or less in 92 %.There was a small, but statistically significant, difference between the endoscopes in the mean time to achieve satisfactory visualisation, with the Olympus MAF taking slightly longer. (Friedman test with Dunn’s post-test, p = 0.01).