A tracheostomy tube can block with thick secretions, blood or a dislodged position, and because it is the patient's main airway this is a life-threatening emergency. Caregivers and responders need a clear step-by-step plan to clear or replace the tube and ventilate the patient.
Key symptoms
- Sudden or worsening shortness of breath
- Noisy breathing, gurgling or whistling from the tube
- Anxiety, agitation or inability to speak with a speaking valve
- No air felt moving at the tube opening
What you find on exam
- Look, listen and feel for airflow at the tube and the mouth
- Oxygen saturation, color, breathing rate and chest movement
- Tube position, ties and stoma; check if the tube is out
- Waveform capnography if available
Tests
- Pass a suction catheter: if it does not go in, the tube is blocked
- Continuous oxygen saturation and end-tidal carbon dioxide
- Chest X-ray after the airway is secure
Treatment basics
- High-flow oxygen to the face and to the trach
- Remove the speaking valve or cap, take out the inner cannula and suction
- Deflate the cuff; if still blocked, remove and replace the tube, one size smaller if needed
- Ventilate with a bag-valve mask over the stoma or over the mouth with the stoma covered
- Start CPR if there is no pulse and call for advanced airway help
Red flags
- Suction catheter will not pass down the tube
- Falling oxygen saturation or cyanosis
- Patient becomes drowsy or unresponsive
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; Open RN, Nursing Skills 2e (Chippewa Valley Technical College). Written by Making Synapses. Making Synapses is not affiliated with these organizations.