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

Published online by Cambridge University Press:  20 April 2009

P J Bradley*
Department of Otorhinolaryngology – Head and Neck Surgery, Nottingham University Hospitals, UK
Address for correspondence: Professor Patrick J Bradley, Department ORL-HNS, Nottingham University Hospitals, Queen's Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK. E-mail:


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.

Review Articles
Copyright © JLO (1984) Limited 2009

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