5. Hemorrhage
Hemorrhage is the presence of blood during tracheostomy aspiration. In some severe cases, bleeding may occur within the tracheostomy tube even without aspiration. Such bleeding should be considered a serious condition and requires appropriate medical intervention. These bleedings can be caused by tracheitis or vulnerable granulation tissue on the trachea. Tracheitis is a bacterial infection of the tracheal mucosa. Frequent aspiration may be required due to increased secretion after infection, which may irritate the tracheal mucosa and cause bleeding. Systemic antibiotics are used in the treatment, and it is recommended to increase hydration. It is also important to use an appropriately sized and correct length suction catheter to avoid tracheal trauma during aspiration 6. There are three techniques for aspiration: ”Shallow aspiration” is the superficial insertion of a catheter into the very core of the tracheostomy tube to remove secretions from the opening. The ”pre-measured technique” is a method that is neither deep nor shallow, in which the farthest side holes are inserted to a certain depth where they emerge from the end of the tracheostomy tube. ”Deep aspiration” is the insertion of the catheter until it meets resistance and then gently withdrawing it before aspiration is applied. Damage and inflammation of the tracheal epithelium are known to occur when deep aspiration is routinely performed, and there are many recommendations for its discontinuation. Pre-measured technique is recommended to minimize airway injury. Determining the exact depth of insertion in the pre-measured technique is crucial to prevent epithelial damage or insufficient aspiration. Marking can be made on a demonstrative catheter using a tracheostomy tube of the same size to measure insertion depth 6.