Complications with Tracheostomies
What incidents can occur with tracheostomies?
Incidents can be classified as:
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Immediate complication: Incidents from time of performing the tracheostomy
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Delayed complication: postoperative period < 7 days
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Late complication: late postoperative period >7 days
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Equipment incidents
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Competency (skills and knowledge) incidents
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Infrastructure (staffing and location) incidents
Each of these is explained in more detail below. Only through anticipation can many of these incidents be
avoided.

Immediate complications
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Bleeding; usually minor, but can be severe if thyroid or blood vessels damaged
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Misplacement of tube - within tissues around trachea or into the main bronchus
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Pneumothorax
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Tube occlusion
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Surgical emphysema
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Loss of the upper airway
Delayed complications
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Tube blockage with secretions or blood. This may be sudden or gradual
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Partial or complete tube displacement
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Infection of the stoma site
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Pneumonia
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Ulceration, and/or necrosis of trachea or mucosal ulceration by tube migration (due to loose tapes or patient intervention)
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The risk of occlusion of the tracheostomy tube in obese or fatigued patients who have difficulty extending their neck
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Tracheo-oesophageal fistula formation
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Haemorrhage (local tissue trauma or erosion through blood vessels)
Late Complications
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Granulomata of the trachea
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Tracheal dilation, stenosis, persistent sinus or collapse (tracheomalacia)
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Scar formation-requiring revision
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Blocked tubes may occur at any time, especially if secretions become thick, the secretions are not managed appropriately (suction), and humidification is not used
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Haemorrhage
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Vocal cord palsy