In these cases, it is important to first verify that the tracheotomy has been adequately dilated. If they has been done, I have found that the problem is with the Shiley tube and trocar. Even if you are meticulously careful aligning the bevel of the tracheostomy tube with the trocar, the edge of the Shiley tracheostomy tube can catch of tracheal rings. It then becomes very difficult to cannulate it into the trachea because any additional pressure or manipulation simply compresses the trachea rather and forcing the Shiley into the trachea.
In these circumstances, what I have found is that the edge of the Shiley tube has been distorted by catching on the tracheal rings. If this has occurred, I have replaced the Shiley tube with a new one and the procedure has proceeded smoothly from there.
Have you ever seen this or had this problem during your perc trachs? Share your experience below.