Managing the Bleeding Tracheostomy

by John Marshall, MD

Early Bleeding: soon after tracheostomy insertion. Think issues with hemostasis. Usually benign, i.e. from manipulation, bleeding from nearby site.

Late bleeding: months after placement.  Possibly a life threatening emergency. Sentinel bleed from innominate artery. Other causes: infection, granulation tissue.

 

Approach:

ABC’s. Attention to clearing airway, suctioning.

Call for help: senior resident/surgery/ENT/ (institution dependent)

Examine tracheostomy site: cuffed vs uncuffed (differentiated by the presence of a pilot balloon port in cuffed, just like endotracheal tubes)

 

If large bleed attempt to control bleed:

Inflating cuff SLOWLY (up to 10-35 cc air)

– If bleeding continues, apply pressure at sternal notch or attempt intubation with OTT, ensuring cuff is distal to stoma opening.

– Addition of blood products if needed.

– All cases to OR for urgent surgical repair.

 

Reference:

Shaukat, Iqbal, Akhtar, Tracheo-innominate fistula formation; a rare complication of tracheostomy, 2013. Lifeinthefastlane.com

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