Bleeding around a tracheostomy wound: what to consider and what to do?

J Laryngol Otol. 2009 Sep;123(9):952-6. doi: 10.1017/S002221510900526X. Epub 2009 Apr 20.


All patients with bleeding in and around a tracheostomy must be investigated to exclude a serious cause. The overall incidence is approximately 5 per cent of tracheostomies performed in Adult Intensive Care Units (AICU). When bleeding commences more than 72 hours post-operatively, the possibility of a trachea innominate artery fistula needs to be excluded by endoscopic examination of the trachea in an operating theatre environment, with the facility to proceed to exploration of the neck and possibly to sternotomy to enable ligation of the innominate artery. With appropriate recognition, diagnosis, resuscitation and surgical intervention, the associated high death rate of trachea innominate artery fistula can be reduced.

Publication types

  • Review

MeSH terms

  • Brachiocephalic Trunk*
  • Diagnosis, Differential
  • Humans
  • Intubation, Intratracheal / adverse effects
  • Postoperative Hemorrhage / etiology*
  • Postoperative Hemorrhage / surgery
  • Practice Guidelines as Topic
  • Respiratory Tract Fistula / complications*
  • Respiratory Tract Fistula / diagnosis
  • Respiratory Tract Fistula / surgery
  • Tracheal Diseases / complications*
  • Tracheal Diseases / diagnosis
  • Tracheal Diseases / surgery
  • Tracheostomy / adverse effects*
  • Vascular Fistula / complications*
  • Vascular Fistula / diagnosis
  • Vascular Fistula / surgery