From the Guidelines
Tracheostomy bleeding can be caused by traumatic suctioning, granulomata, local infection, bleeding disorders, and rarely, but frequently fatal, hemorrhage from tracheo-arterial fistulae. The causes of tracheostomy bleeding can be immediate, early, or late in presentation and can range from minor to life-threatening 1.
Common Causes of Tracheostomy Bleeding
- Traumatic suctioning
- Granulomata
- Local infection
- Bleeding disorders
- Tracheo-arterial fistulae, which can be suspected with moderate bleeding from the stomal site or pulsation of the tracheostomy tube 1
Management of Tracheostomy Bleeding
For minor bleeding, careful observation and conservative management may be sufficient, as most cases settle with no surgical intervention 1. However, tracheo-arterial fistulae should be suspected with moderate bleeding from the stomal site or pulsation of the tracheostomy tube, and immediate action should be taken, including hyperinflation of the tracheostomy tube cuff or intubation of the stoma using a cuffed tracheal tube 1.
Prevention of Tracheostomy Bleeding
Prevention involves proper tracheostomy care, including regular cleaning with sterile saline, ensuring appropriate tube size and position, and minimizing tube movement 1. Humidification of inspired air can help prevent crusting and subsequent trauma. Any bleeding should prompt evaluation for underlying causes, such as coagulopathy, infection, or anatomical issues 1. Patients with recurrent bleeding may need bronchoscopy to identify the source and potentially require surgical intervention to address the underlying cause.
From the Research
Causes of Tracheostomy Bleeding
- Tracheostomy emergencies, including hemorrhage, can occur due to various complications 2, 3, 4
- The greatest life threats to the tracheostomy patient are decannulation, obstruction, and hemorrhage 4
- Bleeding complications can occur in patients undergoing percutaneous tracheostomy, especially in those with risk factors such as thrombocytopenia, use of anticoagulant or antiplatelet agents, and difficult anatomy 5
- Tracheostomy tube dislodgement, obstruction, and stenosis can also lead to bleeding complications 3, 4, 6
- Other complications such as tracheoesophageal fistula, tracheal stenosis, infection, and tracheocutaneous fistula formation can also contribute to bleeding 3, 4
Risk Factors for Bleeding Complications
- Thrombocytopenia 5
- Use of anticoagulant or antiplatelet agents 5
- Difficult anatomy 5
- Presence of multiple risk factors for bleeding complications 5
Management of Tracheostomy Bleeding
- Effective mobilization of secretions and suctioning can help prevent complications, including bleeding 2
- Having necessary supplies readily available at the bedside can help manage tracheostomy emergencies, including bleeding 2
- Understanding tracheostomy basics, features, and complications is essential for managing bleeding complications 3, 4, 6