Complications with Tracheostomies

What incidents can occur with tracheostomies?

Incidents can be classified as:

• Immediate complication: Incidents from time of performing the tracheostomy

• Delayed complication: postoperative period < 7 days

• Late complication: late postoperative period >7 days

• Equipment incidents

• Competency (skills and knowledge) incidents

• Infrastructure (staffing and location) incidents

Each of these is explained in more detail below. Only through anticipation can many of these incidents be

avoided.

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Immediate complications

• Bleeding; usually minor, but can be severe if thyroid or blood vessels damaged

• Misplacement of tube - within tissues around trachea or into the main bronchus

• Pneumothorax

• Tube occlusion

• Surgical emphysema

• Loss of the upper airway

Delayed complications

• Tube blockage with secretions or blood. This may be sudden or gradual

• Partial or complete tube displacement

• Infection of the stoma site

• Pneumonia

• Ulceration, and/or necrosis of trachea or mucosal ulceration by tube migration (due to loose tapes or patient intervention)

• The risk of occlusion of the tracheostomy tube in obese or fatigued patients who have difficulty extending their neck

• Tracheo-oesophageal fistula formation

• Haemorrhage (local tissue trauma or erosion through blood vessels)

Late Complications

• Granulomata of the trachea

• Tracheal dilation, stenosis, persistent sinus or collapse (tracheomalacia)

• Scar formation-requiring revision

• Blocked tubes may occur at any time, especially if secretions become thick, the secretions are not managed appropriately (suction), and humidification is not used

• Haemorrhage

• Vocal cord palsy