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 areas are explained in more detail below.

Only through anticipation can many of these incidents be








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.