Trach complications

[abbythetabby]

Hey,

Can anyone help me out with the causes of tracheostomy complications?

Thanks!

[RNsRWe, ASN, RN]

Do you mean complications arising from the surgery itself, or undesirable conditions that may occur later, during the care and maintenance of one?

[augigi, CNS]

(Just at this part in my NCLEX review, so this is from Saunders)

- Tube obstruction (by secretions)

- Tube dislodgement (client movement, traction on tube, incomplete attachment of the inner and outer cannulae)

- Tracheomalacia: (tracheal dilation and erosion by pressure of the tube)

- Tracheal stenosis: (scar formation from irritated mucosa)

- Tracheoesophageal fistula: (Erosion of posterior trachea wall from excessive cuff pressure, risk increased with concurrent NG tube)

- Trachea-innominate artery fistula: (necrosis and erosion of the innominate artery by the malpositioned tube - emergency)

In practise, 9/10 complications are caused by sputum plugs obstructing the trach tube and are fixed by suctioning/repositioning/coughing/humidification/cleaning inner lumen.

[abbythetabby]

Do you mean complications arising from the surgery itself, or undesirable conditions that may occur later, during the care and maintenance of one?

Sorry to be unclear. I meant complications that occur a month or longer after surgery.

Augigi, thanks! Everywhere I looked, I found the same list of complications but no reason as to why. I could guess, but wasn't sure I was getting all the "whys".

The only other one I have is granulomas. The tube is a foriegn body, so the pt's immune system may mount a response.

[Daytonite, BSN, RN]

you should find the information you are looking for among these websites:

http://www.medicinenet.com/tracheostomy/article.htm - a nice list of the complications is listed here along with the causes

http://www.surgical-tutor.org.uk/default-home.htm?specialities/ent/tracheostomy.htm~right - nice, concise listing that includes the immediate, intermediate and late complication of tracheostomy. to find more information of the late complications i would do a search on e-medicine for the specific condition.

http://www.emedicine.com/ent/topic356.htm#section~complications - this article from e-medicine has information about the late complications of tracheostomy: bleeding, tracheomalacia, stenosis, tracheoesophageal fistula, tracheocutaneous fistula, granulation, scarring, and failure to decannulate.

http://www.orthonurse.org/education/ce/marapr2k/tracheos/sec5text.htm - care of the patient with a tracheostomy. includes complications in early and late stages, causes of them and prevention.

http://www.thoracic.org/sections/education/care-of-the-child-with-a-chronic-tracheostomy/index.html - care of the child with a chronic tracheostomy. at this same site is a short discussion on complications of tracheostomies http://www.thoracic.org/sections/education/care-of-the-child-with-a-chronic-tracheostomy/components-of-tracheostomy-care/complications.html that will give you an idea of some of the problems that may be encountered even though it is talking about pediatric patients.

[abbythetabby]

Thanks Daytonite!

The third link filled in the gaps for me.