There are generally three categories of tracheostomy complications
Immediate after placement, early, and late.
- Immediate and early happen within 48 hours of placement.
- Late happens after
the most concerning late complication is tracheoinnominate fistula
- this is severe with high mortality.
- may be heralded by small amounts of bleeding in the days prior to a large hemorrhage.
- Usually it takes about 5 days for a tracheostomy tract to mature.
- Tracheoinnominate fistula usually occurs in the first three weeks after placement, peaking in the 1st to 2nd week.
Treatment for hemorrhage is pressure
Usually by first hyperinflating the trach tube cuff in attempt to tamponade the bleeding.
If this is unsuccessful, then next is placing a finger in the tracheostomy and applying direct digital pressure by pressing the artery against the manubrium.
Surgical consultation should be immediate. And tamponade of the artery should be maintained to the operating room.
Other complications may be recurring tracheitis or bronchitis related to tracheostomy tube site infection.
Gauze soaked with 0.25% acetic acid can treat local wound infections.
Submitted by J. Stone.
References: Tintinalli’s Emergency Medicine Chapter 242 Compications of Airway Devices; picture