Tracheal Stent Placement and Management

Introduction to Tracheal Stents

The American Thoracic Society recommends that tracheal stents should only be placed when other treatment options have failed, and only when necessary to maintain airway patency 1, 2
Silicone stents are preferred over metal stents for benign diseases due to the long-term complication risk of metal stents, as suggested by the American College of Chest Physicians 3
The FDA has warned about the complications of metal stents in benign tracheal disease since 2005, emphasizing the need for careful selection of stent type, according to the American College of Chest Physicians 1, 2

Other complications include obstruction due to mucus, granulation tissue formation, stent fracture, and infection, with the American College of Chest Physicians noting the importance of monitoring for these complications 2
The American Academy of Otolaryngology-Head and Neck Surgery suggests that complications occur more frequently in the long-term treatment of benign diseases compared to malignant diseases 4

The American College of Chest Physicians recommends that stent fixation should be considered to prevent displacement, especially in cases where the stent is placed near the trachea 1, 2

Patients require clinical monitoring after stent placement due to the risk of stent-related complications, as emphasized by the American College of Chest Physicians 1, 2
Routine endoscopy within 3 months after stent placement does not detect complications unless the patient is symptomatic, making symptom-based endoscopy an accepted approach, according to the American College of Chest Physicians 1, 2
Chest CT can be used to evaluate stent patency or airway clearance to minimize additional invasive procedures, as suggested by the American College of Chest Physicians 1

The use of mucolytic agents like hypertonic saline nebulizers is recommended for secretion management, according to the American Academy of Otolaryngology-Head and Neck Surgery 1
Thick and tenacious secretions can cause tracheal tube obstruction, requiring frequent but careful suctioning to avoid dispersing aerosols, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 4

Foam dressings are preferred over twill tape due to reduced skin tension and lower risk of skin injury, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery 4
If a PEG-TF is used, the external part should be covered with a waterproof dressing during bathing, according to the American Academy of Otolaryngology-Head and Neck Surgery 4
If sutures are used for fixation, they should be removed within 7-10 days, preferably before discharge, unless necessary to ensure airway patency, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 4

The American Society of Anesthesiologists advises against ever clamping a stent with air leaks, as this can convert a simple pneumothorax into a tension pneumothorax 5
Cuff pressure (if applicable) should be maintained at 20-30 cmH2O and checked every 8 hours to avoid mucosal ischemia leading to tracheal stenosis, as recommended by the American Society of Anesthesiologists 6
The depth of stent placement should be clearly documented in the patient's record and prominently displayed in the patient's room, according to the American Society of Anesthesiologists 8, 5