Percutaneous tracheostomy is one of the most commonly performed bedside surgical procedures in critically sick patients. The indications of tracheostomy are: prolonged mechanical ventilation, isolation of airway, easier tracheo-bronchial toileting and oro-dental hygiene. A number of percutaneous tracheostomy kits are available. The latest addition is the ’Ambesh T-Trach Percutaneous Tracheostomy Kit’ which is quite simple to use and economical. The contraindications are: age less than 16 yrs, distorted anat