Staff experiences of percutaneous tracheostomy in intensive care: challenges, complications and potential solutions.

Tracheostomies are performed in 10-13% of UK intensive care admissions. While the percutaneous technique is well established, accurate needle insertion can be difficult in patients with obesity or neck swelling. These challenges increase the risk of bleeding, airway loss and injury to neck structures. In anatomically complex cases, patients are referred for surgical tracheostomy, causing delays and additional healthcare costs. Semi-structured interviews and focus groups were conducted with 32 staff across three intensive care units. Participants included consultants, resident doctors, nurses, advanced practitioners and auxiliary staff. Interviews were recorded, transcribed and analysed using inductive thematic analysis. Six themes were identified. Tracheostomy was seen as a skilled, high-risk procedure best learned through supervised practice. Teamwork, equipment and the environment were considered vital to safety. Staff reported varied approaches to planning and performing the procedure, alongside strategies to prevent and manage complications. Participants reflected on how a guidance device might improve accuracy, drawing on experiences of the benefits and challenges of introducing new technologies into complex clinical settings. This study provides insights into tracheostomy practices, safety strategies and the potential role of guidance devices. Our study also presents a comprehensive end-user co-development model for future medical device design.