When dislodgement occurs, quick recognition and prompt action are key to success. If a suction catheter
cannot be inserted, the tube could be located within a false passage or obstructed by a mucous plug. Table 5 describes the differences between tube dislodgement in a patient who is receiving mechanical ventilation and a patient who is breathing spontaneously in no acute distress. Subcutaneous emphysema or crepitus can occur within the initial incision and move through the stoma into the trachea, allowing air to escape in between the 2 openings. Subcutaneous emphysema, which feels like bubble wrap when palpated, can also be palpated in an inadvertent dislodgement when positive pressure is applied to the tube within a false passage.
Efforts to prevent tube dislodgements will help avoid catastrophic consequences. Preventive measures include keeping tracheostomy ties secure and snug (no more than a single finger
should fit under the
ties), removing
added weight and
traction from the
ventilator circuit, keeping the tracheostomy tube in a midline and neutral position, and minimizing transport of the patient as much as possible. Tube security should be checked frequently and always before the patient is moved in any way.43
Complete decannulation occurs when the tube is completely withdrawn from the stoma. Quick recognition is important because the stoma will begin to close; the newer the stoma, the more quickly it will close. Proper management depends on the maturity of the stoma. An immature stoma (