Tracheostomy complications

Background

• Pts who have undergone a laryngectomy cannot be orally intubated
• Average size:
  • Adult: 5-10mm
  • Peds: 2.5-6.5mm

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