Managing complications of percutaneous tracheostomy and gastrostomy

Abstract

Percutaneous tracheostomy and gastrostomy are some of the most commonly performed procedures at bedside in the intensive care unit. While they are generally considered safe, they can be associated with numerous short and long-term complications, many of which can occur long after their placement and cause significant morbidity. Performers of these procedures should possess a comprehensive understanding of procedural indications and contraindications, and know how to recognize and manage complications that may arise. In this review, we highlight complications of percutaneous tracheostomy and describe strategies for their prevention and management, with a special focus on post-tracheostomy tracheal stenosis. Other complications reviewed include bleeding, pneumothorax and subcutaneous emphysema, posterior wall injury, tube displacement, tracheomalacia, tracheoinominate artery fistula, tracheo-esophageal fistula, and stomal cellulitis. Gastrostomy complications and their management are also discussed including bleeding, internal organ injury, necrotizing fasciitis, aspiration pneumonia, buried bumper syndrome, tumor seeding, wound infection, tube displacement, peristomal leakage, and gastric outlet obstruction. In light of the potentially serious outcomes associated with complications of percutaneous tracheostomy and gastrostomy, the emphasis should be placed on risk-reduction strategies to minimize morbidity and mortality.We therefore present detailed pragmatic and comprehensive checklists to serve as a reference for clinicians involved in performing these procedures.

Hospital-Acquired Anemia in Patients Hospitalized in the Intensive Care Unit: A Retrospective Cohort Study

“…In patients with percutaneous tracheostomy, almost half of patients bled at the insertion site. Bleeding was also the most common complication of tracheostomy in the current report [ 15 ]. Nevertheless, some previous studies reported bleeding complications at 0.6–5% [ 16 ].…”

Prevention of Tracheo-Innominate Artery Fistula by Using an Adjustable Tracheostomy Tube

“…It was found that, due to retrocollis, the trachea was deformed into a C curve and the tip of the tracheostomy tube had attached to the tracheal anterior wall, where the innominate artery transverses. The relationship between tracheal anterior wall compression by the tip of the tracheostomy tube and TIF formation has previously been reported [ 4 - 6 ]. From our CT findings and evidence from the literature, our patients were considered to be at high risk of developing TIF.…”

“…Neck deformity is one of the contributing factors to TIF formation [ 2 , 4 ]. Our two patients with PD and MSA showed a neck extension deformity, so-called retrocollis, after tracheostomy.…”

“…The best treatment for TIF is its prevention and proper tracheostomy care plays a critical role [ 6 , 10 ]. This includes appropriate placement of a tracheostomy tube, its size and material, hygiene, and avoidance of prolonged over-inflation of the cuff [ 4 , 11 ]. Fundamental preventive measures for TIF formation include procedures such as innominate artery ligation [ 3 ].…”

Acute Buried Bumper Syndrome: A Case Report

“…A percutaneous endoscopic gastrostomy (PEG) tube is a standard feeding modality for patients requiring long-term enteral feeding support [1,2], and its use has been increasing since the 1980s [3][4][5]. Buried bumper syndrome (BBS) is a rare but serious long-term complication of PEG tube feeding [6][7][8] and has a prevalence of 1.5% to 9% [2,6].…”