While a tracheostomy can be crucial for individuals with compromised airways, the procedure can lead to complications for some. Serious complications, such as tube dislodgement or infection, may require immediate attention.

A tracheostomy involves inserting a tube directly into the trachea through a surgical opening in the neck. It provides an alternative airway when a person cannot breathe adequately through their nose or mouth due to certain medical conditions or emergencies.

While tracheostomies can be lifesaving interventions, they are not without potential complications, both in the short- and long-term. From bleeding and infections to functional and mental health issues, possible tracheostomy complications vary in severity and impact.

This article looks at tracheostomy complications and how a person can help prevent some of them by taking care of their tracheostomy.

surgeonShare on Pinterest
Halfpoint Images/Getty Images

Below are details of some complications that can occur in the short term:


Bleeding can occur during or shortly after the tracheostomy procedure. This can result from damage to blood vessels in the neck or trachea.

If a person experiences bleeding, they require immediate medical attention to control it and prevent airway compromise.


Infection at the tracheostomy site is another early complication. It can cause symptoms including:

In severe cases, it can lead to deep tissue infections or cellulitis. Prompt evaluation and appropriate management with antibiotics are essential to prevent further complications.

Tube dislodgement

Accidental dislodgement of the tracheostomy tube can occur, particularly during the initial period after the procedure. It can result from improper handling, unintentional pulling, or inadequate tube securing.

In this situation, a person requires immediate intervention to reinsert the tube and restore the airway.

Tube blockage

Tube blockage can occur due to mucus, blood clots, or pressure in the airway. A mucus plug occurs when mucus collects in the tracheostomy tube, becomes hard, and blocks the tube.

Suctioning or exchanging the inner tube may be necessary for a tube blockage.

Below are details of some complications that can occur in the longer term:

Tracheal stenosis

The prolonged presence of a tracheostomy tube can lead to tracheal stenosis. This means that scar tissue formation or prolonged inflammation narrows the trachea.

As a result of stenosis, a person may develop breathing difficulties and require additional treatments, such as tracheal dilation or surgery to improve airflow.

Tracheoesophageal fistula

A tracheoesophageal fistula is an atypical connection between the trachea and the esophagus, the body’s food pipe.

The fistula creates a passageway that allows food, liquids, or gastric contents to enter the airway. A person may then develop respiratory issues, such as:

A person may require surgery to close a fistula.

Tracheo-innominate fistula

A tracheo-innominate artery fistula occurs when atypical communication develops between the trachea and the innominate artery, a major artery.

This condition can be life threatening and warrants immediate medical attention. People may present with bleeding at the tracheostomy site or with tracheal suctioning. Surgery may be necessary to manage this kind of fistula.

Granulation tissue

As the skin at the tracheostomy site attempts to heal, it can grow excessively. This tissue, called granulation tissue, can cause narrowing or blockage of the tracheostomy tube. It can also cause difficulties or bleeding when replacing or changing tracheostomy tubes.

Management may involve regular removal or reduction of the granulation tissue to maintain adequate airflow through the tracheostomy tube. Tissue removal may involve the following approaches:

  • application of silver nitrate
  • electrocautery
  • surgical excision

The specific approach depends on the severity and extent of the granulation tissue.

Below are details of complications that can occur after removing a tracheostomy:

Stoma complications

A stoma may not close on its own. Complications such as infection, delayed wound healing, or scarring can occur at the tracheostomy stoma site after removal.

During healing, people will need to provide proper wound care and monitor the area closely to avoid these issues.

Voice changes

After tracheostomy removal, individuals may experience temporary or permanent changes in their voice quality. This can occur due to vocal cord dysfunction or scarring resulting from the presence of the tracheostomy tube.

Proper care and maintenance of a tracheostomy site are essential to prevent complications and ensure optimal healing.

Here are some key measures that can help people avoid potential issues:

  • Hygiene: Keep the tracheostomy site clean and dry. This may involve the following steps:
    • cleansing the area around the stoma daily using mild soap and water
    • regularly changing and cleaning the tracheostomy dressing or gauze per the doctor’s instructions
    • using sterile techniques when handling the tracheostomy tube, including proper hand hygiene and wearing clean gloves
  • Tube care: Regularly inspect the tracheostomy tube for any signs of damage, blockage, or buildup of secretions. Clean or replace the tube as recommended, usually every 1–3 months.
  • Secretion management: Maintain adequate airway clearance by performing routine tracheostomy tube suctioning as the doctor advises.
  • Skin care: Protect the skin around the tracheostomy site from irritation or breakdown using appropriate barrier creams or ointments. Regularly assess the skin for signs of redness, discoloration, irritation, or pressure ulcers and promptly address any concerns.
  • Showering: Be careful when showering to prevent water from entering the tube. Use a waterproof covering.
  • Follow-up: Attend follow-up appointments with healthcare professionals to monitor the tracheostomy site and address potential issues. Communicate any changes in symptoms, breathing difficulties, or concerns related to the tracheostomy promptly to the healthcare team.

Below are answers to some common questions about potential tracheostomy complications:

What is the most common complication?

One of the most common complications associated with tracheostomy is bleeding. The incidence of major or minor bleeding following tracheostomy is around 5.6%. This statistic refers to the population of the United Kingdom.

Other common complications include tube obstruction, dislodgement, and stomal site infection.

What are life threatening situations with a tracheostomy?

While a tracheostomy is generally a safe procedure, certain life threatening situations may arise. These can include blockage or dislodgment of the tracheostomy tube that causes airway obstruction and severe respiratory infections.

A person can also choke on food, liquid, or secretions that enter the trachea instead of passing through the esophagus into the stomach.

How long can you live with a tracheostomy?

The length of time someone can live with a tracheostomy depends on various factors, including the reason for the tracheostomy, their overall health, and individual circumstances.

A 2022 study looking at mechanical ventilation by a tracheostomy noted that those with a tracheostomy were more likely to die in the hospital than those without. It is important to note that people on ventilation who require a tracheostomy are likely to be sicker and at greater risk of death baseline.

Another 2022 study found that tracheostomy complications could be a risk factor for death.

However, many people have a good quality of life with a permanent tracheostomy tube for a long time.

A tracheostomy is a procedure that creates an alternative airway. While it serves as a critical intervention for individuals with compromised airways, there are potential complications.

These include infection at the stoma site, bleeding, tube dislodgement, granulation tissue formation, and long-term complications such as tracheal narrowing or fistulas.

Tracheostomy care requires diligent attention to hygiene, regular tube maintenance, secretion management, and close communication with healthcare professionals. Individuals can minimize their risk of developing complications by following proper care measures and seeking timely medical support.