Tracheostomy complications: Difference between revisions
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==Diagnosis==
==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===
===Infection===

Revision as of 11:54, 20 July 2015

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[1]:
    • The stoma is the only way to ventilate the patient.
    • Patient cannot be orally intubated

Clinical Features

Differential Diagnosis

Tracheostomy complications

Diagnosis

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

Management

See Also

References

  1. ↑ https://www.ccam.net.au/handbook/tracheostomy/ Date accessed: 4/24/2018
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