From the Guidelines
Bleeding after a tracheostomy is most commonly caused by tracheostomy-related haemorrhage, which can be due to various factors including bleeding diathesis, granulation tissue, wound breakdown, and mucosal or vascular injury.
Causes of Bleeding
- Bleeding diathesis: a condition that affects the blood's ability to clot, increasing the risk of bleeding after a tracheostomy 1
- Granulation tissue: the formation of new tissue around the tracheostomy site, which can lead to bleeding 1
- Wound breakdown: the deterioration of the tracheostomy site, which can cause bleeding 1
- Mucosal or vascular injury: damage to the mucous membranes or blood vessels in the trachea, which can lead to bleeding 1
- Traumatic suctioning: the use of suctioning devices that can cause trauma to the trachea, leading to bleeding 1
- Tracheo-arterial fistulae: a rare but potentially life-threatening complication where a fistula forms between the trachea and a nearby artery, leading to bleeding 1
Management of Bleeding
The management of bleeding after a tracheostomy depends on the severity and cause of the bleeding. Minor bleeding can be managed conservatively with observation, while more severe bleeding may require surgical intervention 1. It is essential to suspect tracheo-arterial fistulae in cases of moderate bleeding from the stomal site or pulsation of the tracheostomy tube, and to take immediate action to control the bleeding and prepare for definitive surgical treatment 1.
From the Research
Causes of Bleeding after Tracheostomy
The causes of bleeding after a tracheostomy can be attributed to several factors, including:
- Vascular complications, such as erosion of major vessels, including the brachiocephalic trunk, carotid artery, and thyroid artery 2, 3, 4
- Tracheoarterial fistula, which can occur due to mucosal damage, pressure necrosis, or mucosal trauma from an improperly positioned cannula tip 3
- Bleeding from small cervical vessels 2
- Infection, hypotension, malnutrition, and corticosteroid use, which can increase the risk of bleeding 3
- Improper surgical technique, including low-lying tracheostomy tube placement 3, 4
- Slippage of ligatures from adjacent vessels, such as the thyroid artery 4
Risk Factors for Bleeding
Several risk factors can increase the likelihood of bleeding after a tracheostomy, including:
- Patient anatomical and physiologic factors 5
- Operator skill and experience 5
- Specific approach to tracheostomy 5
- Presence of infection or malignant neoplastic invasion of adjacent vessels 3, 4
Prevention and Management of Bleeding
Prevention and management of bleeding after tracheostomy are crucial to minimize complications. Measures to prevent tracheal damage, such as proper surgical technique and proper inflation of the tracheostomy tube cuff, can help avoid bleeding 3. In cases of bleeding, immediate action is necessary, including over-inflation of the cuff and protection of the airway 4. Definitive repair, including vascular reconstruction, may be necessary in some cases 2, 3, 6.