Give 4 examples of delayed (post-procedure) complications following tracheostomy insertion?

Immediate (During Insertion)
  • Arrest and Death (1/600)
  • Haemorrhage (minor or severe) - 4.8%
  • Misplacement (pre-tracheal tissues or to main bronchus)
  • Hypoxia
  • Injury to local structures:
    • Pneumothorax and surgical emphysema
    • Oesophageal perforation
    • Vascular injury
    • Thyroid injury
    • Posterior tracheal wall injury
    • Laryngeal nerve damage
    • Tracheal ring fracture
  • Air embolism
  • Equipment issues:
    • Incorrect tube / size
    • Equipment malfunction
Delayed (Post Insertion)
  • Tube blockage with secretions (may be sudden or gradual) 1
  • Tube migration to pre-tracheal space 1
  • Accidental decannulation 1
  • Infection:
    • Stoma site 1
    • Bronchial tree 1
    • VAP 1
  • Erosion related:
    • Tracheal ulceration or necrosis 1
    • Tracheo-oesophageal fistula formation 1
    • Tracheo-innominate fistula 1
Late (Post Decannulation)
  • Tracheal injury / dysfunction:
    • Tracheal stenosis at the cuff site
    • Tracheomalacia
    • Vocal cord dysfunction
    • Persistent sinus at the tracheostomy site
  • Granulomata of the trachea
  • Tracheo-innominate fistula
  • Psychological impact related to stoma