Tracheostomy complications: Difference between revisions

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==Background==
==Background==
*Pts who have undergone a laryngectomy cannot be orally intubated
{{Tracheostomy background}}
*Average size:
**Adult: 5-10mm
**Peds: 2.5-6.5mm


==Obstruction==
==Clinical Features==
*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==
==Differential Diagnosis==
*Determine whether tube is dislodged from the trachea, but not from the neck
{{Tracheostomy DDX}}
**Does a suction catheter pass without difficulty?  If not, remove the tube


==Infection==
==Evaluation==
*Give broad-spectrum abx (cover staph, pseudomonas, candida)
*Attempt to find out if patient has a tracheostomy vs laryngectomy from history. If the latter is present, the stoma is the only way to ventilate the patient.<ref>https://www.ccam.net.au/handbook/tracheostomy/ Date accessed: 4/24/2018</ref>


==Bleeding==
==Management<ref>National Tracheostomy Safety Project. Review date 1/4/2014</ref>==
*Local Bleeding
*Call for airway expert help
**Use silver nitrate if bleeding source is identified
*Sit patient up or in a position of comfort
*Brisk Bleeding
*Place on trach collar oxygen or place non-rebreather mask mask on trachesostmy while preparing
**Tracheoinnominate artery fistula until proven otherwise
**If any doubt about tracheosomy vs. laryngectomy, be sure to oxygenate nasal/oral airway in addition to stoma
***Most pts present within first 3wk after tracheostomy
*Don faceshield, have suction, oxygen, flushes (possibly surgical airway supplies)
***Treatment:
*Remove speaking valve or cap (if present)
****1. Hyperinflate the cuff (85% successful)
*Remove inner cannula
****2. If above fails, withdraw tube while placing pressure against anterior trachea
*If unable to pass suction catheter at this point, deflate cuff and consider removing tracheostomy tube
*****Apply digital pressure of innominate artery against the manubrium
 
****3. If above fails, place a cuffed ET tube to prevent pulmonary aspiration of blood
==Disposition==


==See Also==
==See Also==
*[[Tracheostomy Types]]
*[[Medical device complications]]
*[[Surgical airways]]


==Source==
==External Links==
Tintinalli
*Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/


==References==
<references/>
[[Category:ENT]]
[[Category:ENT]]
[[Category:Surgery]]
[[Category:Pulmonary]]

Revision as of 19:35, 8 September 2020

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

Evaluation

  • Attempt to find out if patient has a tracheostomy vs laryngectomy from history. If the latter is present, the stoma is the only way to ventilate the patient.[2]

Management[3]

  • Call for airway expert help
  • Sit patient up or in a position of comfort
  • Place on trach collar oxygen or place non-rebreather mask mask on trachesostmy while preparing
    • If any doubt about tracheosomy vs. laryngectomy, be sure to oxygenate nasal/oral airway in addition to stoma
  • Don faceshield, have suction, oxygen, flushes (possibly surgical airway supplies)
  • Remove speaking valve or cap (if present)
  • Remove inner cannula
  • If unable to pass suction catheter at this point, deflate cuff and consider removing tracheostomy tube

Disposition

See Also

External Links

References

  1. https://www.ccam.net.au/handbook/tracheostomy/ Date accessed: 4/24/2018
  2. https://www.ccam.net.au/handbook/tracheostomy/ Date accessed: 4/24/2018
  3. National Tracheostomy Safety Project. Review date 1/4/2014