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

What should be suspected if bleeding occurs in the airway or around the stoma more than 48 hours after a tracheostomy?

1. Accidental decannulation

2. Tracheal dilation

3. Tracheoinnominate artery fistula

4. Pneumothorax

The correct answer is: Tracheoinnominate artery fistula

If bleeding occurs in the airway or around the stoma more than 48 hours after a tracheostomy, it raises the suspicion of a tracheoinnominate artery fistula. This complication is a serious concern, particularly in patients who have undergone a tracheostomy, as it involves erosion or damage to the tracheal wall leading to an abnormal connection between the trachea and the innominate artery. The timing of the bleeding is significant; if it occurs later rather than immediately after the procedure, it suggests potential complications like this rather than issues related to the initial surgical site or direct trauma. The tracheoinnominate artery is located anatomically close to the trachea, and injury to it can lead to life-threatening hemorrhage, which is often characterized by sudden, massive bleeding from the tracheostomy site or airway. In contrast, accidental decannulation typically occurs shortly after the procedure and would not be associated with delayed bleeding. Likewise, tracheal dilation is less likely to cause significant bleeding around the stoma. As for pneumothorax, it is primarily associated with pleural space issues rather than direct bleeding from the stoma itself. Thus, the nature and timing of the bleeding strongly