From the Guidelines
Management of tracheostomy site bleeding requires prompt assessment and intervention based on the severity of bleeding, with the primary goal of preventing morbidity, mortality, and improving quality of life. For minor bleeding, direct pressure should be applied to the site using sterile gauze for 10-15 minutes, as recommended by general medical principles 1. The site should then be cleaned with sterile saline and an antimicrobial solution like chlorhexidine. Topical hemostatic agents such as silver nitrate sticks can be used to cauterize small bleeding vessels, and absorbable hemostatic materials like Surgicel or Gelfoam may be applied.
Key Considerations
- For moderate bleeding, in addition to these measures, the tracheostomy tube may need to be replaced with a cuffed tube and the cuff inflated to tamponade bleeding, as suggested by 1.
- Systemic medications like tranexamic acid (1g IV followed by 1g over 8 hours) can help stabilize clots.
- Severe bleeding requires immediate surgical consultation, possible endoscopy to identify the source, and may necessitate surgical repair or embolization of bleeding vessels.
Preventive Measures
- Regular monitoring of vital signs and hemoglobin levels is essential during management.
- Preventive measures include proper tracheostomy care, humidification to prevent crusting, and gentle suctioning techniques to avoid trauma to the tracheal mucosa, as outlined in 1 and 1.
Underlying Cause
- The underlying cause of bleeding should be addressed, which may include treating infection with appropriate antibiotics, correcting coagulopathies with vitamin K or fresh frozen plasma, or adjusting anticoagulant medications, as implied by 1 and 1.
From the Research
Management of Trach Site Bleeding
- Tracheostomy site bleeding is a potential complication of tracheostomy, and its management is crucial to prevent serious consequences 2.
- In case of bleeding, the first-aid measure is to over inflate the cuff without removing the tracheostomy tube 2.
- Tracheo-arterial fistula after tracheostomy can cause massive hemorrhage, and factors responsible for fistula include pressure from the tube, infection, and malignant neoplastic invasion of a vessel near the trachea 2.
- Low tracheostomy below the third ring should be avoided to prevent complications such as bleeding 2.
Prevention of Trach Site Bleeding
- Proper care and management of the tracheostomy site can help prevent bleeding complications 3.
- The use of a suction catheter is essential for effective mobilization of secretions and prevention of complications 3.
- Having a functional suctioning system, an oxygen source, a manual resuscitation bag, and a complete tracheostomy kit at the bedside can help manage tracheostomy emergencies, including bleeding 3.
Tracheostomy Care and Complications
- Tracheostomy care involves providing proper care to tracheostomy patients to prevent complications, including infection, tracheomalacia, skin breakdown, and tracheoesophageal fistula 3.
- Tracheostomy emergencies, such as hemorrhage, tube dislodgement, and tube obstruction, require prompt management, and having necessary supplies readily available at the bedside can help manage these emergencies effectively 3, 4.
- Percutaneous tracheostomy is a relatively safe procedure with a low rate of complications, even in patients deemed to be at high risk of bleeding complications 5.