Tracheostomy complications: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Tracheostomy complications=== | ===Tracheostomy complications=== | ||
*Tracheostomy obstruction | |||
*Tracheostomy dislodgement | |||
*Tracheostomy infection | |||
*Tracheostomy bleeding | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 11:48, 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
Tracheostomy complications
- Tracheostomy obstruction
- Tracheostomy dislodgement
- Tracheostomy infection
- Tracheostomy bleeding
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