Saunders Respiratory Practice

How may tracheoesophageal fistula be suspected in a client with a tracheostomy tube?

1. There is excessive coughing

2. The client has difficulty speaking

3. Aspiration of gastric contents occurs when suctioning

4. The tracheostomy site is swollen

The correct answer is: Aspiration of gastric contents occurs when suctioning

Tracheoesophageal fistula (TEF) is an abnormal connection between the trachea and the esophagus, which can lead to significant respiratory complications, particularly in clients with a tracheostomy. Suspecting TEF involves recognizing signs that indicate the presence of this abnormal connection. When suctioning a client with a tracheostomy, if gastric contents are aspirated, it strongly suggests that there is a direct connection between the esophagus and the trachea. This occurs because in a healthy system, the esophagus and trachea remain separate, allowing for the effective management of airway secretions without the risk of introducing oral or gastric contents into the respiratory tract. The aspiration of gastric contents is significant because it can lead to aspiration pneumonia and other serious complications. Hence, this symptom is a key indicator for suspecting the presence of a tracheoesophageal fistula. Difficulty speaking and excessive coughing may occur in a person with a tracheostomy tube, but these symptoms are more commonly related to other respiratory issues or complications of the tracheostomy itself rather than directly indicating a TEF. Swelling at the tracheostomy site could suggest infection or irritation but does not in itself point to a fistula. Thus