Common Complications with Tracheostomy Tubes and How to Manage Them

When working with tracheostomy tubes, it’s important to be prepared for complications along the way. While these tubes are vital for many patients, they come with their own set of challenges. Let’s chat about some common complications you might encounter.

Tube Obstruction

One of the most common issues is tube obstruction. This can happen when mucus, dried secretions, or even blood clots block the tube. You might notice the patient struggling to breathe, hear a whistling sound (stridor), or see a decrease in airflow.

So, what can you do? Regular suctioning is a good start to keep the tube clear. It’s also helpful to humidify the air the patient breathes. This helps keep the secretions moist and less likely to clog things up. If the obstruction just won’t budge, you might need to replace the tube altogether. Keeping the airway clear is key to patient comfort and safety.

Infection

Infections are another potential headache. The area around the tracheostomy site can get infected if bacteria find their way in, especially if the site isn’t kept clean. Look out for signs like redness, swelling, discharge, or a fever.

To keep infections at bay, maintaining good hygiene is crucial. Clean the stoma site regularly, change the dressing often, and if you do notice signs of infection, it might be time for antibiotics. It’s important to keep an eye on things and act quickly if something seems off.

Accidental Decannulation

Accidental decannulation is something you want to avoid, but it can happen. This could be due to improper securing of the tube, patient movement, or even during a routine tube change. The patient might suddenly struggle to breathe, which can be a sign the tube has come out.

To manage this, it’s essential to have a plan. Make sure you and your team are trained to quickly and safely reinsert the tube if it comes out. It’s also a good idea to keep spare tubes of the same size and also one size smaller nearby, just in case. And, of course, make sure the tube is well-secured to minimize the risk of it coming out accidentally.

Granulation Tissue Formation

Lastly, let’s talk about granulation tissue. This can form around the stoma as the body’s response to irritation from the tube. It’s usually not dangerous, but it can cause bleeding or make tube changes tricky.

To manage granulation tissue, you can use topical steroids to reduce inflammation. Silver nitrate is another option to cauterize the tissue. If it becomes a bigger issue or obstructs the airway, it might be time to get an ENT specialist involved.

Conclusion

Managing tracheostomy tubes isn’t without its challenges, but being aware of these common complications can help you stay ahead of them. With a little vigilance and some practical strategies, you can keep your patients safe.