Podcast 788: Tracheostomy Bleeding

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Tracheostomy bleeding is a rare but potentially life-threatening complication that usually occurs within the first month of tracheostomy tube placement</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">No matter how severe the bleeding, every patient should be evaluated to rule out a tracheo-innominate fistula between the tracheostomy and the innominate artery</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">If the patient is currently bleeding and has a cuffed tracheostomy tube, over-inflate the balloon to compress the bleeding vessel</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Consider replacing an uncuffed tracheostomy tube with a cuffed tube or an ET tube</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">If the tracheostomy was performed in the last seven days, use a bougie or bronchoscope to replace the uncuffed tube due to increased risk of opening a false track into the subcutaneous tissue</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">If bleeding cannot be controlled, follow mass-transfusion protocols, and as a last resort, remove the tube and insert a finger into the stoma to manually compress the artery</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Bontempo LJ, Manning SL. Tracheostomy Emergencies.</span> <em><span style= "font-weight: 400;">Emerg Med Clin North Am.</span></em> <span style="font-weight: 400;">2019;37(1):109-119.</span></p> <p><span style="font-weight: 400;">Khanafer A, Hellstern V, Meißner H, et al. Tracheoinnominate fistula: acute bleeding and hypovolemic shock due to a trachea-innominate artery fistula after long-term tracheostomy, treated with a st