Post-Tracheostomy Complications

There are two ways to categorize complications. Immediate surgical complications and late complications
•  Hemorrhage
Massive bleeding may occur a few days to several weeks post–op. Delayed hemorrhage may be due to erosion of the tracheal wall. The tip of the tube may then perforate a major blood vessel usually the innominate artery.
•  Wound Infections
Infection at the tracheostomy site may be minor and respond to local treatment. Serious mediastinus can result from an untreated tracheostomy wound infection.
•  Tracheitis
A dry tracheitis will develop if humidification of the airway is inadequate. Secondary infections may require treatment with antibiotics.
•  Pneumonia
Aseptic technique during surgery and trach care including suctioning can prevent pneumonia or lung abscess. Please use sterile suction catheter or closed suction system to avoid bacterial invasion of respiratory system.
•  Subglottic edema
Usually associated with infants and children when the incision is made via the 1 st or 2 nd tracheal cartilage. Edema of the subglottic area may develop. The swelling of the mucosa will restrict the airway above the tube and can be difficult to decannulate the patient.
•  Tracheal stenosis
This is the narrowing of the trachea by stenotic grannula tissue (scar tissue). This narrowing can occur at the : Tracheal opening Cuff site Position of tube tip
•  Tracheoesophageal Fistula
The posterior wall of the trachea erodes into the underlying esophagus. This complication is rare but if it occurs it is potentially fatal. Monitoring cuff volumes and having a properly sized trach tube helps to decrease this incident.

Tracheal stenosis at the cuff site can be avoided by using a trach tube with a low volume cuff and monitoring the cuff pressure. Erosion of the tip of the wall can be decreased by tube used (proper length, size and curvature). Many tubes now soften slightly with the patient's body temperature, which allows the tube to conform to the patient's trachea. Movable neck plates also help in the process for the tube to conform to the trachea