From the Guidelines
To get a tracheostomy tube back in after it has been dislodged, first call for help immediately as this is an emergency situation, and then position the patient with their neck slightly extended and identify the stoma opening. Using a clean or sterile technique, gently insert the tracheostomy tube following the natural curve of the airway, aiming downward and slightly backward. If the original tube cannot be reinserted, use a smaller size tube or the emergency tracheostomy tube from the bedside kit, as recommended by the American Thoracic Society 1. Never force the tube as this can create a false passage and cause tissue damage, and always prioritize the patient's airway and breathing, as emphasized in the multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies 1. Some key points to consider when reinserting the tracheostomy tube include:
- Checking the tube integrity and flexibility before insertion, as well as cuff integrity if present 1
- Using an obturator in a new tube if necessary, and suctioning the child's tracheostomy tube before reinsertion 1
- Positioning the child with neck in slight extension, using a small roll under shoulders, and deflating the cuff if present before reinsertion 1
- Inserting the new tube in a downward, inward arc, and immediately removing the obturator if used 1
- Securing the tube with tracheostomy ties to prevent it from dislodging again, and suctioning may be needed to clear secretions 1. It is also important to note that the selection of a tracheostomy tube of the proper diameter, length, and curvature for the individual patient will minimize the incidence of potential complications, as stated in the care of the child with a chronic tracheostomy guidelines 1. Additionally, having a tracheostomy tube one size smaller than usual available for emergency use is recommended, in case the same-size tracheostomy tube cannot be inserted after accidental decannulation 1. This procedure requires training and ideally should be performed by healthcare professionals, but in emergency situations when healthcare providers aren't immediately available, knowing these steps can be lifesaving as oxygen deprivation can occur quickly when a tracheostomy tube is out, as highlighted in the multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies 1.
From the Research
Tracheostomy Tube Displacement
- A tracheostomy tube can slip out of the trachea, especially in patients with a full neck or those who are overweight, as the tube must pass through a greater amount of soft tissue 2.
- Displacement of the tracheostomy tube can lead to immediate respiratory distress and potentially respiratory arrest, especially if the patient has complete obstruction of the upper airway 2.
Reinsertion of Tracheostomy Tube
- There is no direct evidence in the provided studies on the specific procedure for reinserting a tracheostomy tube that has been displaced.
- However, the studies discuss the importance of proper tracheostomy care and management to prevent complications, including displacement of the tube 3, 4.
Tracheostomy Care and Management
- Tracheostomy care involves recognizing the patient with a displaced tracheostomy tube and taking immediate action to prevent respiratory distress 2.
- Nurses play a crucial role in caring for patients before, during, and after tracheostomy insertion, including managing tracheostomy-related complications and emergencies 3.
- The timing and technique of tracheostomy insertion are important considerations, with percutaneous dilational techniques being associated with a lower risk of complications 5, 4, 6.