Problems Associated with a trach
Tracheostomies, like most surgical procedures, do have many risks which could arise from complications. Some complications are predominantly likely to occur during or shortly after surgery. The risks of such complications greatly increases when the tracheotomy is performed as an emergency procedure.
Early complications can occur in up to 32% of patients (1) and can include:
- Bleeding and infection occurring at the surgery location. Minor bleeding can occur in up to 80% of patients, while major bleeding can occur in up to 7% of patients. (15)
- Air trapped around the lungs (pneumothorax [noo-mo-THOR-aks]) can occur in up to 4% of patients. (15) This is a condition in which air or gas can build up in the space between the lungs and chest wall. A pneumothorax can cause sudden pain in one side of the lung and shortness of breath. When this occurs, pressure on the lung can cause it to collapse. A severe pneumothorax can cause severe compromise and if unless treated in a timely manner death.
- Air trapped in the deeper layers of the chest (pneumomediastinum [noo-mo-mee-dee-uh-STY-num)
- Air trapped underneath the skin around the tracheostomy (subcutaneous emphysema) can occur in up to 11% of patients.(15) This condition can cause damage to the trachea or food pipe (esophagus), as well as problems breathing
- Injury to the vocal cord nerve (recurrent laryngeal [lar-en-GEE-al] nerve)
- Damage to the swallowing tube (esophagus), which is the passage leading from your mouth to your stomach
- Misplacement or displacement of the tracheostomy tube. During the early phase post op any attempt to replace the trach tube in the stoma on accidental dislodgement has a high chance of the tube being advanced into the tissues of the neck and not into the trachea this may result in a high potential for all of the previously described complications. This is why often the trach tube is sutured or sown down to the neck for the first few days.
Later complications can occur in up to 65% of patients (15) and can include:
- Unintentional removal of the tracheostomy tube (inadvertent decannulation).This can be a potentially disastrous problem. It can be caused by a variety of reasons including inadequately secured tubes, frequent coughing, patient movement, or even short/thick neck or obesity. Some studies have recorded a displacement rate of up to 15% of patients.(15)
- Infection in the trachea and around the tracheostomy tube, which can occur in up to 63% of patients. (15) Advanced trach stoma infections can result in necrotic tissue involvement in which the infected area sluffs off and can leave a highly enlarge stoma or a large wound adjacent that is very difficult to heal and predisposed the patient to sepsis if not resolved.
- Pressure ulcers can develop if pressure from the ventilator tubing or other elements place any significant amount of pressure on the trach which is transmitted to the trach base plate then to the skin beneath
- Windpipe itself may become damaged from a number of conditions, including pressure from the tube; bacteria that cause infections and form scar tissue; or erosion from tube movement
- Abnormal tissue masses, or granulations [GRAN-yoo-LA-shuns], in the airways
- Narrowing or collapse of the airway above the trach tube’s location, can occur in up to 8% of patients. (15)
- Irritation of the windpipe’s inside lining from the tube rubbing against the lining’s surface
- Blockage of the tracheostomy from dried secretions and mucus masses (also called plugs) can occur spontaneously at any time if inadequate hydration and humidification are not maintained
- Obstruction of the tracheostomy tube kinking of the tube or a herniated trach cuff
- Development of an irregular passage between the trachea and esophagus (fistula), which can increase the danger of fluids or food entering the lungs
- Development of a passage between the trachea and the innominate [in-nom-mi-nayt] artery (tracheoinnominate fistula), which can generate life-threatening bleeding
- Bacterial conditions, which may cause illness, such as pneumonia
- Tracheostomy tubes can be obstructed by blood clots, mucus or pressure of the airway walls. Obstructions will need to be continually treated by using suctioning, humidification of the air, and using the proper fitting tracheostomy tube.
The risks associated with tracheostomies are higher if patients are:
- children, especially newborns and infants
- alcohol abusers
- persons with chronic diseases or respiratory infections
- patients with compromised immune systems
- persons taking steroids or cortisone