A tracheostomy is a surgically created opening in the trachea (windpipe), usually with a tube inserted to facilitate breathing. This opening provides an alternative airway, often for individuals with respiratory difficulties or blockages in their upper airway. The tracheostomy tube keeps this passage open, allowing air to reach the lungs. If this tube accidentally comes out, it is a serious medical emergency requiring immediate action. This situation can lead to rapid airway compromise and severe breathing difficulties.
Immediate Actions for Tracheostomy Dislodgement
Remaining calm is the first step when a tracheostomy tube dislodges, allowing for a more effective assessment. Immediately check if the individual is breathing, observe their skin color for any bluish tint, and note their level of consciousness. Position the person on their back to optimize airway alignment. Gently extending the neck by placing a small roll under the shoulders can further improve airway access, provided there is no suspected neck or spinal injury.
If the tracheostomy tube is completely out, quickly cover the stoma with a clean hand or sterile gauze. This prevents air from escaping and helps maintain airway pressure, potentially encouraging air to pass through the natural upper airway or facilitating ventilation. If breathing is compromised, use basic airway opening techniques like the jaw thrust or chin lift. A jaw thrust maneuver lifts the jaw forward without tilting the head, which is suitable if a spinal injury is a concern.
Reinsertion of a dislodged tracheostomy tube should only be attempted by individuals who have received specific training for this procedure. For trained caregivers, a spare tracheostomy tube, typically with an obturator (a guide) in place, is used for reinsertion. The tube is inserted gently into the stoma, aiming downward and slightly backward, following the natural curve of the airway. Never force the tube, as this can cause tissue damage or create a false passage, complicating the airway.
After successful reinsertion, the obturator must be removed immediately, as the individual cannot breathe with it in place. If the original tube cannot be reinserted, a smaller size tracheostomy tube from the emergency kit should be used as an alternative. If reinsertion is not possible or the individual’s breathing remains severely compromised, manual ventilation can be performed using a bag-valve mask. This device can be applied over the mouth and nose, ensuring a tight seal, or, if trained and equipped, directly over the stoma to deliver breaths into the trachea.
When to Seek Emergency Medical Care
Seek emergency medical care promptly if a tracheostomy tube dislodges and the situation cannot be resolved with basic interventions. Call emergency services immediately if the individual is not breathing, exhibits severe respiratory distress such as gasping or struggling for air, or shows signs of a bluish discoloration of the lips or skin, known as cyanosis. Loss of consciousness also requires an urgent emergency call.
Even if trained individuals attempt reinsertion unsuccessfully, or if distress persists despite initial actions, medical help is required. When contacting emergency services, provide clear and concise information. State that a tracheostomy tube has dislodged, describe the individual’s current condition, including whether they are breathing or conscious, and mention the type and size of the tracheostomy tube if known.
Inform the emergency dispatcher about any actions already taken. Continue monitoring the individual’s breathing and level of consciousness until medical personnel arrive. This ongoing observation helps guide the emergency team’s response and interventions upon their arrival.
Preparation and Prevention Strategies
Preventing tracheostomy tube dislodgement involves careful attention to securing the tube and regular assessment. The tracheostomy tube must be properly secured with specialized ties or straps that are snug but not overly tight, allowing for approximately one finger to fit comfortably underneath. Regularly checking the tube’s position and the security of its ties is a daily practice. Avoiding any pulling or tugging on the tube, especially during movement or care, can help maintain its stable placement.
Proper care of the stoma also helps prevent dislodgement. Maintaining a clean and healthy stoma site helps prevent irritation, infection, or the formation of granulation tissue, which could affect the tube’s stability. Consistent stoma care reduces the risk of complications that might lead to accidental dislodgement.
Being prepared for a dislodgement emergency involves having specific supplies readily available. An emergency kit should contain:
At least two spare tracheostomy tubes: one of the same size as the one currently in use and another that is one size smaller.
An obturator, which is a guide used for tube reinsertion.
Suction equipment to clear secretions.
A bag-valve mask for manual ventilation.
A stoma dilator to help keep the opening patent during reinsertion attempts.
Knowing the specific type and size of the tracheostomy tube is also beneficial for quick and effective management. Caregivers should receive comprehensive training on emergency procedures, including basic life support and specific techniques for tracheostomy care and reinsertion.