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. 2014 Sep 18;18(5):514. doi: 10.1186/s13054-014-0514-0

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© Rudas et al.; licensee BioMed Central Ltd. 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Risk associated with lateral tracheal puncture. Downward force (dashed black arrow) applied during dilation of the tract can be broken up into force vectors which are perpendicular (blue arrow) and parallel (red arrow) to the tracheal wall (black line). At a 90° angle, all of the force is perpendicular. With the angle becoming more oblique, hitting the lateral curve of the tracheal wall, there is an increasing proportion of the downward force which is parallel to the wall and a decreasing proportion directed towards the tracheal lumen. This can lead to bending of the guidewire and subsequent paratracheal tract dilation or tearing of the tracheal wall itself.