Complications can be divided into those associated with insertion of the tracheostomy (surgical or percutaneous) or those which arise following the procedure (usually blocked or displaced tracheostomy tubes).
These can be serious and sometimes fatal.
These complications are usually grouped as follows:
- Immediate complications (perioperative period)
- Delayed complications (postoperative period < 7 days)
- Late complications (late postoperative period >7 days)
Displaced tracheotomy tubes
Immediate complications (perioperative period)
- Haemorrhage (usually minor, but can be severe if thyroid or blood vessels damaged)
- Misplacement of tube - within tissues around trachea or to main bronchus
- Pneumothorax (Fig 1)
- Tube occlusion
- Surgical emphysema
- Loss of the upper airway
Fig 1 Pneumothorax
Delayed complications (postoperative period < 7 days)
- Tube blockage with secretions or blood. May be sudden or gradual
- Partial or complete tube displacement
- Infection of the stoma site
- Infection of the bronchial tree (pneumonia)
- Ulceration, and/or necrosis of trachea or mucosal ulceration by tube migration (due to loose tapes or patient intervention)
- Risk of occlusion of the tracheostomy tube in obese or fatigued patients who have difficulty extending their neck
- Tracheo-oesophageal fistula formation
- Haemorrhage (local tissue trauma or erosion through blood vessels)
Late Complications (late postoperative period >7 days)
- Granulomata of the trachea may cause respiratory difficulty when the tracheostomy tube is removed
- Tracheal dilation, stenosis, persistent sinus or collapse (tracheomalacia)
- Scar formation-requiring revision
- Blocked tubes may occur at any time, especially if secretions become thick, the secretions are not managed appropriately (suction) and humidification is not used
- Haemorrhage