The purpose of this paper is to summarize the nursing experience of a patient who developed a tracheo-mediastinal fistula following bronchoscopic balloon dilation for severe central airway stenosis due to tuberculosis. Key nursing points include: early recognition of complications; enhanced monitoring of the patient's condition to watch for recurrence of the fistula; dynamic monitoring of the circulatory system to prevent obstructive shock; evidence-based and standardized care for indwelling catheters; meticulous management throughout the course of treatment to eliminate mediastinal and subcutaneous emphysema; monitoring thrombus detachment and appropriate anticoagulant therapy; improving discharge guidance and continuous nursing. After effective treatment and careful nursing, the patient made a full recovery and was discharged smoothly.