Tracheostomy Complications

Respiratory Distress and Tube Obstruction

Mucus plugs are the most common cause of respiratory distress for children with tracheostomies. Symptoms of a mucus plug include resistance when trying to suction or bag and/or signs of respiratory distress.

Symptoms of Respiratory Distress

Respiratory Distress

Illustration Source:
The Center for Pediatric Emergency Medicine (CPEM), Teaching Resource for Instructors in Prehospital Pediatrics.  Illustrations by Susan Gilbert.

Suction trach or change trach tube as needed for respiratory distress. The tube may have become blocked with dried secretions or blood. If symptoms do not clear with suction or trach change, call the doctor or 911, go directly to the emergency room, or call an ambulance.


Very small amounts of bleeding (pink or red streaked mucus) often occurs as a result of routine suctioning. This bleeding can be managed with close observation and by modifying the care that might have caused the problem.

Possible Causes of Minor Bleeding

Call your doctor, emergency services, or go directly to your local emergency room for a significant amount of bright red bleeding from the tracheostomy.


Children with tracheostomies are at high risk for respiratory infections. The trach tube bypasses the natural defenses (nasal hair and mucus membranes) of the upper airway that filter out dust and bacteria. Also, monitor for local infections at the stoma site. Hand washing before any trach care is one of the best defenses against infection.

Symptoms of Infection

A dry tracheitis is an infection in the trachea that may develop if humidification of the airway is inadequate.

Call the doctor for symptoms of infection.

Other Complications

Tracheal Stenosis
Scar tissue at the site of the tracheostomy tube, often from excessive trach cuff pressure.

Tracheoesophageal Fistula
An abnormal connection between the trachea and the esophagus resulting from erosion of the back wall of the trachea.

Granuloma (common)
A growth of inflammatory tissue, which is caused by the irritation of the airway by the tracheostomy tube.


Granuloma inside trachea, just about trachoestomy tube. (white area)


Granuloma at stoma  (Photo courtesy of Kerry S. Baldwin)

Pressure Necrosis
Infants with short, fat necks or children on mechanical ventilation may develop infections or pressure sores of the skin and soft tissue around the trach site. Inspect skin daily.

Tracheoinnominate Fistula (rare)
An erosion of the tube into a large artery that runs in front of the trachea. Hemorrhage could lead to death if not stopped.

Accidental Decannulation (What to Do If the Trach Tube Comes Out Accidentally)

Cardiac Apnea Monitor

Cardiac Apnea Monitor

What to Do If Your Child Pulls on the Trach Tube

CPR with a Tracheostomy

All parents and caregivers should be trained in cardiopulmonary resuscitation (CPR). In fact, infant and child CPR classes for parents are required before a baby can be discharged from many Neonatal Intensive Care Units (NICU). Although it is not the purpose site to teach CPR, I would like to point out some important differences when delivering CPR to an infant or child with a tracheostomy tube.

If the Child is Not Breathing

More about CPR with a tracheostomy from The Children's Mercy Hospitals and Clinics

This page updated 05/14/07