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