From the Guidelines
Aspiration in a tracheostomy patient requires immediate removal of the tracheostomy tube if it is completely blocked or displaced and the patient cannot breathe around the tube adequately. This is based on the most recent and highest quality study available, which emphasizes the importance of prompt action in emergency situations 1. The study highlights that continued attempts at rescue ventilation will not be effective if the airway is obstructed, and the tracheostomy tube offers no benefit with considerable potential for harm.
Key Considerations
- If a suction catheter cannot be passed and deflating the cuff fails to improve the clinical condition, the tracheostomy tube may be completely blocked or displaced 1.
- Removal of the tracheostomy tube is necessary when faced with a deteriorating patient with an obstructed airway 1.
- Following tracheostomy tube removal, reassessment at both airways (mouth and trachea) is required, ensuring oxygen is reapplied to face and stoma 1.
Special Circumstances
- In cases of a known difficult or obstructed upper airway, or previously difficult-to-insert tracheostomy, fibreoptic inspection of the tube whilst it remains in situ may be necessary 1.
- However, this should not delay the removal of a blocked or displaced tube when faced with a deteriorating patient 1.
General Management
- After removing the tracheostomy tube, the patient should be reassessed, and oxygen should be reapplied to the face and stoma 1.
- Definitive management of the airway, such as re-insertion of a tracheostomy or oral tube, may not be required immediately if the patient is not hypoxic 1.
From the Research
Aspiration in Trach Patients Treatment
- Aspiration is a significant concern in patients with tracheostomy tubes, and various studies have investigated the best approaches to prevent and manage aspiration in these patients.
- A study published in 2020 2 found that using continuous high-flow oxygen therapy with frequency of suctioning as an indicator of readiness for decannulation led to shorter time to decannulation and lower incidence of pneumonia and tracheobronchitis compared to the traditional 24-hour capping trial approach.
- Another study from 2020 3 highlighted the importance of proper tracheostomy care, including suctioning and humidification, in preventing complications such as aspiration.
- A 1999 study 4 discussed the importance of proper tracheal suctioning and humidification techniques in preventing aspiration and other complications in tracheostomy patients.
- The American Association for Respiratory Care (AARC) published a clinical practice guideline in 2021 5 that provides recommendations for the management of adult patients with tracheostomy in the acute care setting, including the use of tracheostomy bundles, multidisciplinary tracheostomy teams, and weaning/decannulation protocols to improve outcomes and reduce complications such as aspiration.
- A 2014 article 6 outlined the essential principles of tracheostomy care in adult patients, including the importance of proper suctioning and humidification techniques in preventing aspiration and other complications.
Tracheostomy Care and Aspiration Prevention
- Proper tracheostomy care, including regular suctioning and humidification, is crucial in preventing aspiration and other complications in patients with tracheostomy tubes.
- The use of tracheostomy bundles, multidisciplinary tracheostomy teams, and weaning/decannulation protocols can help improve outcomes and reduce complications such as aspiration in tracheostomy patients 5.
- Nurses play a critical role in providing proper tracheostomy care and preventing aspiration in patients with tracheostomy tubes 3, 6.
Treatment Approaches
- Continuous high-flow oxygen therapy with frequency of suctioning as an indicator of readiness for decannulation may be a more effective approach than the traditional 24-hour capping trial approach in reducing time to decannulation and preventing complications such as aspiration 2.
- The use of tracheostomy bundles, multidisciplinary tracheostomy teams, and weaning/decannulation protocols can help improve outcomes and reduce complications such as aspiration in tracheostomy patients 5.