Tracheostomy complications

Background

Tracheostomy Sizes

(1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea (A) Cricothyrotomy site (B) Tracheotomy site

Tracheotomy in situ
1 – Vocal folds
2 – Thyroid cartilage
3 – Cricoid cartilage
4 – Tracheal rings
5 – Balloon cuff

Shiley™ trach tube

• Average size:
  • Adult: 5-10mm
  • Peds: 2.5-6.5mm

Tracheostomy vs laryngectomy

It is important to differentiate between tracheostomy vs laryngectomy

• If laryngectomy:
  • The stoma is the only way to ventilate the patient.
  • Patient cannot be orally intubated

Differential Diagnosis

Tracheostomy complications

• Tracheostomy obstruction
• Tracheostomy dislodgement
• Tracheostomy infection
• Tracheostomy bleeding

Diagnosis

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