Medical Oncologist
CION Cancer Clinics
Bleeding from a tracheostomy: what is normal and what is not | CION Cancer Clinics
A few streaks of blood in the mucus or a little oozing around the opening are common after a tracheostomy and usually settle. Bright red blood coming up through the tube, bleeding that keeps flowing, or a warning bleed that stops on its own needs hospital care the same day. This page explains what each kind of bleeding means, what to do at home, and when to call 108. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Is bleeding from a tracheostomy an emergency?
- What kind of bleeding is it?
- What can you do about minor bleeding?
- What do the bleeding words mean?
- What do families often believe about tracheostomy bleeding?
- Who is more likely to bleed, and what should you ask?
- Common questions about bleeding from a tracheostomy
The short answer
Is bleeding from a tracheostomy an emergency?
A few streaks of blood in the mucus, or a little oozing around the opening, are common and usually not an emergency. Bright red blood coming up through the tube, blood that keeps flowing, or a tube that pulses with the heartbeat is an emergency. For that, call 108 at once.
Why some bleeding is expected
The windpipe lining is delicate. In the first days after the operation, the wound edges ooze. Later, dry air, rough suction and the tube rubbing on the lining can all cause small amounts of bleeding. These usually settle once the cause is dealt with.
Why a larger bleed is treated seriously
Rarely, the tube wears against a large blood vessel that runs just in front of the windpipe. This kind of bleed is often preceded by a smaller warning bleed of bright red blood that stops on its own. A warning bleed that stops is still a reason to go to hospital the same day, not to wait and watch.
This page cannot tell you why your own tracheostomy is bleeding. Only someone who examines the opening, and sometimes looks inside the windpipe with a camera, can say that.
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When bleeding cannot wait
If bright red blood is coming up through the tube, soaking gauze, or the person is coughing up more than streaks, call 108 and say "tracheostomy, heavy bleeding". Sit them up and lean them forward so blood drains out. Suction the tube to keep the airway clear. Press on bleeding around the outside of the opening with gauze, but never push anything into the tube.
Not sure whether this applies to you?
Ask an oncologistReading what you see
What kind of bleeding is it?
Where the blood comes from, how much there is and what colour it is tell you most of what you need to know.
Pink or streaked mucus
Thin lines of blood in mucus after suction or coughing. Usually from a dry or irritated lining. Common and often settles with more moisture and gentler suction.
Oozing around the opening
Blood on the dressing from the skin edge. Often from soft red lumpy tissue that forms where the tube rubs. It bleeds easily but is rarely serious.
Dark blood or old clots
Brown or dark red clots coughed up in the first days after surgery are usually old blood clearing out. Tell the team, but it is not usually an emergency.
Fresh bright red blood
Bright red blood from inside the tube, in more than streaks, is never normal. Treat it as urgent even if it stops.
Go the same day if
- It fills the suction catheter
- The tube moves with each heartbeat
- It came once and stopped
Small bleeds at home
What can you do about minor bleeding?
Check the amount
Look at the gauze and the suction catheter. Streaks and spots are minor. Anything more, or anything bright red from inside the tube, is not.
Suction more gently
Pass the catheter only to the depth you were shown, and only when the tube sounds wet. Suctioning too deep or too often scrapes the lining.
Add moisture to the air
Use the humidifier, filter or saline your team advised. A moist lining bleeds far less than a dry, crusted one.
Look after the skin
Clean around the opening gently and check the ties are not too tight. Tell the team about red lumpy tissue at the edge.
Call if it continues
If streaks keep appearing for more than a day, or bleeding increases, call your team the same day.
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What the team may say
What do the bleeding words mean?
- Stoma
- The opening in the front of the neck that the tube sits in.
- Granulation tissue
- Soft, red, lumpy healing tissue that forms around the opening. It bleeds easily when touched and can be treated simply in clinic.
- Herald bleed
- A smaller warning bleed of bright red blood that can come before a larger one. It always needs same-day review.
- Blood thinners
- Medicines such as aspirin, clopidogrel, warfarin or apixaban that make blood clot more slowly and can make bleeding heavier.
- Bronchoscopy
- A look inside the windpipe with a thin camera, to find where bleeding is coming from.
Commonly believed
What do families often believe about tracheostomy bleeding?
"It stopped on its own, so there is nothing to worry about."
For streaks, often true. For a bright red bleed from inside the tube, no. A bleed that stops can be a warning of a larger one. Go to hospital the same day, even if the person now looks well.
"He is on a blood thinner, so we stopped it after the bleeding."
Never stop, start or change a blood thinner without the doctor who prescribed it. Stopping one suddenly can cause a stroke or a clot. Tell the team what he takes, and let them decide.
"Stuffing gauze into the tube will stop the blood."
Anything pushed into the tube blocks the airway. Press only on the skin around the outside. Keep the inside of the tube clear with suction.
"Turmeric paste on the opening will heal the bleeding skin."
Pastes and powders can fall into the tube and irritate the lining. Use only what the team gave you. Red, bleeding tissue at the edge has simple treatments in clinic.
Before it happens
Who is more likely to bleed, and what should you ask?
Bleeding is more likely in the first days after surgery, in people taking blood thinners, after radiotherapy to the neck, and where the tube has been in for a long time or sits at an awkward angle.
When the cancer is close to the opening
Sometimes the cancer itself grows near the tracheostomy, and bleeding comes from the tumour. If this applies, ask your team to talk through a plan with you in advance. That plan might include dark towels at home, who to call, and what the family would want to happen. Every family decides this differently, and there is no wrong choice.
Questions for your team
Ask which medicines raise the risk of bleeding, and who decides about them before and after surgery. Ask how much blood is normal for you right now, and at what point to call. Ask whether your tube should be checked for fit, and write down the answers on your emergency card.
Questions we are asked
Common questions about bleeding from a tracheostomy
Is a little blood after suction normal?
A few streaks after suction are common, especially when the air is dry or suction goes too deep. Pass the catheter only as far as you were shown and add moisture to the air. If streaks keep coming, become heavier or turn bright red, call your team the same day.
What should I do if bright red blood comes out of the tube?
Call 108. Sit the person up and lean them forward so blood drains out rather than down. Suction the tube to keep it clear. Press on any bleeding at the skin around the opening. Do not put gauze or cloth into the tube, and do not drive yourself if help can come to you.
Why is there red lumpy tissue around the opening?
It is usually granulation tissue, extra healing tissue that forms where the tube or ties rub. It bleeds easily when cleaned. It is not usually dangerous, and your team can treat it in clinic. Tell them, and check the tube is sitting straight and the ties are not too tight.
Should he stop his aspirin if the tracheostomy bleeds?
Not on your own. Aspirin and other blood thinners are often prescribed for the heart or to prevent stroke, and stopping them has its own risks. Tell the surgeon and the doctor who prescribed the medicine about the bleeding. They will decide together whether anything should change.
Can dry air really cause bleeding?
Yes. Air breathed through a tracheostomy skips the nose, which normally moistens it. The lining of the windpipe dries, cracks and forms crusts that bleed when coughed or suctioned. Using the humidifier or filter your team advised is one of the simplest ways to reduce bleeding.
Is bleeding a sign the cancer has come back?
Usually not. Most tracheostomy bleeding comes from irritation, dryness or healing tissue. Sometimes, though, bleeding does come from a tumour near the opening, so any unexplained or repeated bleeding should be examined. Only a check by your team can say what is causing it.
What will the hospital do for a serious bleed?
They will first make sure the airway stays open, sometimes by changing the tube. They may look inside the windpipe with a camera and arrange scans to find the source. Treatment depends on what they find and may include a procedure or an operation. They will explain the options as they go.
How do we tell a bleed from blood-stained mucus?
Blood-stained mucus is mostly mucus with thin red or pink lines, or a pinkish tinge. A bleed is mostly blood, bright red, that fills the catheter, soaks gauze or keeps coming. If you cannot tell, or you are worried, treat it as a bleed and call.
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Sources
- NHS — Tracheostomy
- National Cancer Institute — Tracheostomy (NCI Dictionary of Cancer Terms)
- American Cancer Society — Surgery for laryngeal and hypopharyngeal cancer
- Macmillan Cancer Support — Head and neck cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Suctioning at Home: How to Do It SafelyGentler suction means less bleedingHumidification and Preventing CrustingWhy dry air makes the lining bleedBlocked Tube: The Emergency Every Family Must KnowWhen clots block the tubeMedicines Around Cancer SurgeryBlood thinners and who decides about themComplications and Red FlagsOther warning signs after cancer surgery
Talk to us
Worried about bleeding from a tracheostomy?
For heavy bleeding, call 108 first. For anything else, call the helpline and a surgical oncologist or nurse will help you decide what to do next. One helpline serves every CION centre.