Tracheostomy complications: Difference between revisions
m (Rossdonaldson1 moved page Tracheostomy Complications to Tracheostomy complications) |
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**Peds: 2.5-6.5mm | **Peds: 2.5-6.5mm | ||
==Obstruction== | ==Clinical Features== | ||
==Differential Diagnosis== | |||
==Diagnosis== | |||
===Obstruction=== | |||
*Rule-out other causes of respiratory distress before assuming it is d/t obstruction | *Rule-out other causes of respiratory distress before assuming it is d/t obstruction | ||
*Preoxygenate and place sterile saline solution into trachea and then suction | *Preoxygenate and place sterile saline solution into trachea and then suction | ||
**If this fails, inner cannula of tube can be removed and cleaned | **If this fails, inner cannula of tube can be removed and cleaned | ||
==Dislodgement== | ===Dislodgement=== | ||
*Determine whether tube is dislodged from the trachea, but not from the neck | *Determine whether tube is dislodged from the trachea, but not from the neck | ||
**Does a suction catheter pass without difficulty? If not, remove the tube | **Does a suction catheter pass without difficulty? If not, remove the tube | ||
==Infection== | ===Infection=== | ||
*Give broad-spectrum abx (cover staph, pseudomonas, candida) | *Give broad-spectrum abx (cover staph, pseudomonas, candida) | ||
==Bleeding== | ===Bleeding=== | ||
*Local Bleeding | *Local Bleeding | ||
**Use silver nitrate if bleeding source is identified | **Use silver nitrate if bleeding source is identified | ||
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==See Also== | ==See Also== | ||
== | ==References== | ||
[[Category:ENT]] | [[Category:ENT]] | ||
Revision as of 11:47, 20 July 2015
Background
- Pts who have undergone a laryngectomy cannot be orally intubated
- Average size:
- Adult: 5-10mm
- Peds: 2.5-6.5mm
Clinical Features
Differential Diagnosis
Diagnosis
Obstruction
- Rule-out other causes of respiratory distress before assuming it is d/t obstruction
- Preoxygenate and place sterile saline solution into trachea and then suction
- If this fails, inner cannula of tube can be removed and cleaned
Dislodgement
- Determine whether tube is dislodged from the trachea, but not from the neck
- Does a suction catheter pass without difficulty? If not, remove the tube
Infection
- Give broad-spectrum abx (cover staph, pseudomonas, candida)
Bleeding
- Local Bleeding
- Use silver nitrate if bleeding source is identified
- Brisk Bleeding
- Tracheoinnominate artery fistula until proven otherwise
- Most pts present within first 3wk after tracheostomy
- Treatment:
- 1. Hyperinflate the cuff (85% successful)
- 2. If above fails, withdraw tube while placing pressure against anterior trachea
- Apply digital pressure of innominate artery against the manubrium
- 3. If above fails, place a cuffed ET tube to prevent pulmonary aspiration of blood
- Tracheoinnominate artery fistula until proven otherwise