ANAESTHETICS AND AIRWAY
TRACHEOSTOMY (TROUBLESHOOTING)
Austin health guidelines probably easiest to follow. Laryngectomy is different as no airway above cords - ie: you can’t intubate through the mouth or nose
PromptComplications of long term tracheostomies
ResponseMucous Plugging
Bleeding
Infection
Tracheo-oesophageal fistula
Tracheal stenosis / subglottic stenosis
Tracheal innominate vessel fistula
Accidental decanulation
Any other reasonable
Bleeding
Infection
Tracheo-oesophageal fistula
Tracheal stenosis / subglottic stenosis
Tracheal innominate vessel fistula
Accidental decanulation
Any other reasonable
PromptImmediate management of blocked tracheostomy (bloody sputum)
ResponseApply FiO2 100% to face and tracheostomy
Remove inner cannula or speaking valve and attempt FiO2 100% BVM
If not resolved, attempt to pass suction catheter and oxygenate via tracheostomy if successful
If not able to pass suction catheter: deflate cuff and attempt to allow patient to breathe around or BVM applied around tracheostomy
If unable to do this, remove tracheostomy and attempt replacement
If unable to replace then proceed to RSI with direct laryngoscopy or surgical airway depending on indication for tracheostomy
Remove inner cannula or speaking valve and attempt FiO2 100% BVM
If not resolved, attempt to pass suction catheter and oxygenate via tracheostomy if successful
If not able to pass suction catheter: deflate cuff and attempt to allow patient to breathe around or BVM applied around tracheostomy
If unable to do this, remove tracheostomy and attempt replacement
If unable to replace then proceed to RSI with direct laryngoscopy or surgical airway depending on indication for tracheostomy
PromptOngoing management of bleeding from tracheostomy site
ResponseNotification to anaesthetics, ENT/ vascular for urgent management in theatre . +/‐ Intervention radiology
Thrombostatic medications: TXA 1g, reversal of anticoagulation
Early use of blood products, activation of MTP and use of minimal volume resuscitation technique if bleeding profuse
Slowly hyper‐inflate tracheostomy cuff with 10‐35mL air 5.
If this fails to stop bleeding, attempt RSI with oral ETT, remove tracheostomy and then manually compress fistula against posterior border of the sternum
Thrombostatic medications: TXA 1g, reversal of anticoagulation
Early use of blood products, activation of MTP and use of minimal volume resuscitation technique if bleeding profuse
Slowly hyper‐inflate tracheostomy cuff with 10‐35mL air 5.
If this fails to stop bleeding, attempt RSI with oral ETT, remove tracheostomy and then manually compress fistula against posterior border of the sternum
PromptCauses of bleeding in Tracheostomy
ResponseGranulation tissue
Tracheo‐Innominate artery fistula
Suction trauma
Infection
Coagulopathy
Tracheo‐Innominate artery fistula
Suction trauma
Infection
Coagulopathy