J Postgrad Med
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Percutaneous tracheostomy to a large extent has replaced conventional surgical tracheostomy by virtue of its low incidence of complications and the rapidity with which the procedure can be performed at the bedside avoiding transport of critically ill patients to the operating rooms. Since it is a blind approach, bronchoscopic guidance has been suggested which might not always be possible due to logistic reasons. ⋯ In the absence of bronchoscopic guidance, adopting the simple but effective precaution of free movement of guide wire at each step of the procedure, a safe tracheostomy tube placement is possible.