Saunders Respiratory Practice

What should the nurse monitor for in a client receiving mechanical ventilation through a tracheostomy?

1. Temperature changes

2. Signs of infection at the site

3. Complications such as tracheoesophageal fistula

4. Oxygen saturation levels

The correct answer is: Complications such as tracheoesophageal fistula

Monitoring for complications such as tracheoesophageal fistula in a client receiving mechanical ventilation through a tracheostomy is vital due to the potential for serious airway and gastrointestinal complications. A tracheoesophageal fistula can occur as a result of pressure necrosis from the tracheostomy tube or from inappropriate cuff pressure. This complication presents with aspiration of food or secretions into the trachea, leading to potentially life-threatening situations. Early identification allows for timely intervention, which can significantly reduce morbidity and improve outcomes for the patient. While monitoring temperature changes, signs of infection at the site, and oxygen saturation levels are all important aspects of care in mechanically ventilated patients, the specific concern of a tracheoesophageal fistula is directly related to the integrity and positioning of the tracheostomy tube itself and signifies a more acute and less common complication that necessitates vigilant observation. Proper understanding and monitoring for such complications demonstrate a comprehensive approach to managing patients with tracheostomies and mechanical ventilation.