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Difficulty Inserting the New Tracheostomy Tube

Do not panic. Carefully follow the instructions below to ensure the patient will be oxygenated.

  1. Check to make sure the patient is positioned optimally with the chin pointing toward the ceiling and the neck extended.
  2. Try to reinsert the tracheostomy tube. Do not force the tube into the tract.
  3. If it still does not enter, try to reinsert the old tube. Since this tube was in before, it should pass into the stoma without difficulty again.
  4. If the old tracheostomy tube does not fit, try a tracheostomy tube that is smaller than the size the patient normally uses. Always keep a smaller tracheostomy tube available when changing the tube.
  5. If this measure is still unsuccessful, take a suction catheter and put it in the stoma. Hold it in place and cut it approximately 5 cm or 2 inches from the stoma. This catheter will keep the stoma open.
  6. Try to insert the old tracheostomy tube over the suction catheter. Always hold the catheter to prevent migration into the trachea (windpipe).
  7. If the above measures fail, administer oxygen if the patient normally requires oxygen. If it is evident the patient is able to breathe via his/her mouth, the Ambu bag can be used and placed over the mouth; otherwise just direct the oxygen toward the stoma.
  8. Call 911. Also remember to call your surgeon’s office.
performing a tracheostomy

If the tracheostomy tube falls out

Do not panic.

  1. If the patient normally required oxygen and/or is on a ventilator, place oxygen over the tracheal stoma site.
  2. Gather the equipment needed for the tracheostomy tube change. An assistant can do this while the other caregiver administers oxygen.
  3. Always have a clean tracheostomy tube and ties available at all times.
  4. Wash your hands if you have time.
  5. Put the obturator in the new tracheostomy tube and put a few drops of water on the end.
  6. Remove the old tracheostomy tube if it is around the neck. If it is partially in the stoma, you can try to gently reinsert the old tracheostomy tube. If you cannot insert the old tube, go to the 7th step.
  7. Insert the new tracheostomy tube and quickly remove the obturator.
  8. Reinsert the inner cannula.
  9. Secure the tracheostomy ties.