American Association of Critical-Care Nurses (AACN) Certification Practice Test

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What serious complication can arise from tracheostomy placement?

Tracheal stenosis
Tracheoinnominate artery fistula
Pneumothorax
Subcutaneous emphysema

The correct answer is: Tracheoinnominate artery fistula

Tracheoinnominate artery fistula is a serious complication that can arise from tracheostomy placement. This condition occurs when the trachea, which is positioned anteriorly to the innominate artery, becomes eroded or injured, leading to a direct communication between the trachea and the artery. This can result in life-threatening hemorrhage due to the close anatomical proximity of these structures. The development of a tracheoinnominate artery fistula is particularly concerning because it can occur in patients with prolonged tracheostomy use or improper tube placement. The risk increases with inappropriate cuff pressure or prolonged compression of the trachea by the tubing. The clinical manifestations may include sudden and severe bleeding from the tracheostomy site, which requires immediate medical intervention to prevent fatal outcomes. Recognizing the potential for this complication is critical for healthcare providers managing patients with tracheostomies, emphasizing the importance of proper technique during placement and ongoing care to monitor for signs of erosion or tissue compromise.