Trachaeostomy

Question 1

History of bleeding in Trachaeostomy

Answer 1

• date of insertion
• Indication for trachaeostomy
• known underlying complication
• Anticoagulation
• Recent URTI or LRTI
• Duration of bleeding
• Tubing: Brand, ?inner tube, ?cuff

Question 2

Complications of Trachaeostomy

Answer 2

1. Tube dislodgement
2. Obstruction - oxygenate from above, replace tube if >14 days
3. Bleeding : (<2 weeks old) infection/suctioning Mx: inflate cuff, apply direct pressure, topical silver nitrate
   Bleeding : > 2weeks old:
4. Tracheoinominate fistula (trachea-innominate artery)
5. Thyroid vessel erosion
6. Infection
7. Granulation tissue

Question 3

Management of low rate bleeding

Answer 3

1. Inspect site
2. Mild manipulation
3. Suction to clear any clot
4. Cauterise bleed from granulation tissue
5. Inflate balloon to 50ml & gentle traction

Question 4

Management of Catastrophic bleeding

Answer 4

1. Ventilate from above
2. Remove trachaeostomy
3. Intubate from above
4. Insert finger into stoma & pull anteriorly to occlude Innominate artery.
   Ix; CT angiography