Brachiocephalic artery haemorrhage during percutaneous tracheostomy

• Published in: Annals of the Royal College of Surgeons of England Vol. 97; no. 2; pp. e15 - e17
• Main Authors: Sharma, S D, Kumar, G, Hill, C S, Kaddour, H
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-03-2015; Royal College of Surgeons
• Subjects: Aged; Brachiocephalic Trunk - abnormalities; Brachiocephalic Trunk - diagnostic imaging; Brachiocephalic Trunk - injuries; Brachiocephalic Trunk - surgery; Female; Hemorrhage - etiology; Hemorrhage - surgery; Humans; Intensive care; Medical imaging; Online Case report; Ostomy; Otolaryngology; Radiography; Surgery; Thyroid gland; Tracheostomy - adverse effects; Ultrasonic imaging; Veins & arteries; Ventilator Weaning - adverse effects; United Kingdom > UK; United States > US
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588414X14055925060118

Percutaneous tracheostomy was performed on a 69-year-old woman to facilitate weaning. Insertion of the size 7 tracheostomy tube resulted in profuse bleeding around the tracheostomy site. On inflation of the tracheostomy balloon, the bleeding stopped. Urgent computed tomography demonstrated the brachiocephalic artery was abnormally high and lying in an oblique fashion over the trachea, and the tracheostomy tube was displacing the trachea posteriorly. Surgical repair of the defect in the brachiocephalic artery was undertaken and a surgical tracheostomy was performed in theatre. This case raises important issues about the potential dangers of percutaneous tracheostomy in cases of abnormal anatomy. It also emphasises the importance of direct visualisation of the seeker needle using the endoscope. In cases where there is a suspicion of abnormal anatomy, it is safer to obtain preprocedural imaging or perform a surgical tracheostomy.