Airway obstruction is a catastrophic complication of tracheostomy. We report the case of an 85-year-old female whose bronchoscopy revealed tracheal wound oozing with blood clots retained around the tracheal wound. When changing the tracheostomy tube, she developed difficult ventilation and severe hypoxia due to massive blood clots and required peri-operative resuscitation. There are few reports in the literature about airway obstruction due to massive blood clots. The management of this condition may rely on suction or forceps under fiberoptic bronchoscopy, surgical removal and fibrinolytics into the airway. A detailed bronchoscopy should be performed just before changing the tracheostomy tube to find any retained blood clots which may cause severe airwayobstruction. (J Taiwan Otolaryngol Head Neck Surg 2023; 58:136-142)
