COMPLICATIONS AND POST-OPERATIVE MANAGEMENT OF TRACHEOSTOMY
- Immediate: They present before or at termination of the surgery.
- Bleeding commonly from the thyroid isthmus, anterior jugular and inferior thyroid veins.
- Damage to recurrent laryngeal nerve.
- Damage to pleura.
- Apnea due to loss of hypoxic respiratory stimulation.
- Injury to cricoid cartilage (In high tracheostomy).
- Vagal stimulation.
- False passage of the tracheostomy tube.
- Anesthetic complications.
Delayed or intermediate: They occur during the first few hours or days after the tracheostomy.
- Surgical emphysema.
- Aspiration and lung abscess.
- Tracheitis and tracheobronchitis especially in children.
- Pneumothorax and pneumomediastinum may occur if the surgical emphysema progress.
- Dysphagia due to pressure on oesophagus.
- Blockage of tube.
- Dislocation of the tube.
III. Late complications: They are the most common complications especially in prolonged tracheostomies.
- Localized tracheomalacia.
- Tracheo-oesophageal fistula may occur due to an inadvertent incision on the posterior tracheal wall.
- Tracheal stenosis due to injuries or perichondritis of cricoid cartilage.
- Tracheo-cutaneous fistula.
- Difficulty in de-cannulation.
- Localized tracheomalacia occurs at the superior part of the tracheostomy opening if the tube is too large or sharply angled.
Postoperative management is required for tracheostomy patients:
A tracheostomy patient requires diligence and patience.
The tracheostomy tube should be kept in situ for 2-3 days before it can be changed and the tract is well formed.
- A fresh tracheostomy tube and dilator must be kept near the patient.
- As the patient cannot speak, a bell should be kept next to the patient.
- Inner tube is removed and cleaned every one or two hours in the first 48 hours after tracheostomy. Later it can be cleaned every four hours.
- Suction with aseptic precautions must be done every half an hour.
- Humidification of the inhaled air is necessary to prevent tracheitis and crust formation. This can be done using a Walton’s humidifier or ultrasonic nebulizer in the room.
- Mesna is a potent mucolytic available as 200 mg/ml solution for nebulization and tracheopulmonary instillation via the tracheostomy tube. It is a therapeutic agent that aims specifically on the dissociation of mucous plugs. It instantly removes the sputum and clears the airway passage and normalizes the gaseous exchange.
- Chest physiotherapy is required to clear any accumulated secretions.
- Local dressing to be changed every day using sterile gauze and anti-septic cream to avoid skin erosion and wound infection.
- Mucolytic agents and expectorants.
- Antibiotics in cases of chest or wound infections.