What to Do If a Trach Is Dislodged?

Reviewed on 1/8/2021
When a tube is dislodged, it requires immediate attempts at manual ventilation.
When a tube is dislodged, it requires immediate attempts at manual ventilation.

When a tube is dislodged, it requires immediate attempts at manual ventilation. The caregiver should perform suctioning with a solution of sodium chloride, which the doctor would explain at the time of performing the tracheostomy. This will rule out a mucus plug and prevent brain damage. The cuff of the tracheostomy tube should be immediately deflated, and the tracheostomy tube should be removed. Further attempts at ventilation through the tracheostomy tube should be avoided, as this can force air into the surrounding soft tissues instead of the lungs, leading to complications. If the tracheostomy is new, only a doctor should reinsert the tube; hence, medical attention is required.

The following steps may be followed to ensure the patient remains oxygenated:

  • The patient should be positioned appropriately with the chin pointing toward the ceiling and the neck extended.
  • If the tracheostomy is old, the caregiver may try to reinsert the tracheostomy tube gently. If there is a difficulty, the caregiver can try reinserting the old tracheostomy tube or a tube that is smaller than the one the patient uses. It is advised to consult the doctor once the airway is secure.
  • A suction catheter can be put in the stoma (the tracheostomy hole) to remove mucus plugs or excessive secretions.
  • The caregiver may administer oxygen if the patient normally requires oxygen.
  • The patient may then be taken to the emergency room (ER) or doctor who performed the tracheostomy as soon as possible.

Why does the trach get dislodged?

The tracheostomy tube may get dislodged due to the following reasons:

  • The breathing process itself
  • Simple movements of the head/neck/body
  • While moving and rolling of the patient by medical staff and caregivers

Certain factors increase the risk of dislodgement of the tube; these include:

  • A relatively recently performed tracheostomy
  • Larger or obese patients
  • Patients with thick and/or short necks
  • Low tracheostomy placement
  • High patient movement
  • Loose tracheal ties
  • Traction on ventilatory tubing
  • Use of positive-pressure ventilation

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References
https://emedicine.medscape.com/article/2051313-overview

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342618/

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