What Should Be Done if a Tracheostomy Tube Becomes Accidentally Dislodged?
Question
What should be done if a tracheostomy tube becomes accidentally dislodged?
Answer
Accidental decannulation is another emergency, though it is not always truly accidental. Some patients repeatedly pull out their own tracheostomy tubes. In some cases, patients do not want the tracheostomy at all, but family members making decisions on their behalf, holding a health care proxy, do not authorize decannulation, and we have to continue reinserting the tube by the rules. Often, patients pull at the tube out of confusion or simply to occupy their hands; giving them another object to handle can sometimes redirect that behavior.
True accidental decannulation can also happen. A cuff balloon may rupture, or the ties may not be secure enough, allowing the tube to come out. This requires acting very quickly, since a stoma can close within seconds, or narrow significantly even if it does not close completely. An emergency tracheostomy kit with a spare tube should always be kept at the bedside, as the same tube cannot be reinserted due to infection control. Because a stoma can close quickly, it is wise to keep not only a same-size replacement tube on hand but also one size smaller, for example, keeping both a size 8 and a size 6 tracheostomy tube in the drawer. The same size should always be tried first, but if it will not pass and time is running out, particularly in a long-term care setting without immediate hospital transfer, a smaller tube may need to be used to manage the airway.
The tie should not be too tight or too loose. Too tight causes pain and can break the skin; too loose fails to hold the tube securely, which risks displacement and airway obstruction. A good way to check the fit is to make sure two fingers can fit between the tie and the neck on each side, not three or one. Proper fit helps prevent accidental decannulation due to a strong cough or during patient repositioning.
This Ask the Expert is an edited excerpt presented by Zhanna Sorin, BSRT, RRT.
Zhanna Sorin
BSRT, RRT
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