Tube Obstruction
Figure 4 is an algorithm for managing tube obstruction. The first step in caring for a tracheostomy patient in respiratory distress is to remove and inspect the inner cannula. If the cannula is clogged with secretions, it can be quickly cleaned and/or replaced with a new one. If the patient remains in distress, the nurse should immediately call for help and then attempt to insert a suction catheter. Easy passage of the suction catheter with return of tracheal secretions confirms that the tube is in proper position. If resistance is encountered during passage of the suction catheter, the tube may be partially obstructed with secretions. If a suction catheter cannot be passed, or can be passed only a few centimeters (the length of the tracheostomy tube), the tube may be clogged with secretions or lodged within a false passage. At that point, management differs, depending on the maturity of the stoma. In a patient with a mature stoma, the entire tube should be replaced.43 When the stoma is immature, mask ventilation with the cuff deflated is usually the best intervention, and then an orotracheal tube should be inserted.48 After the airway is secure, the tracheostomy can be revised under more controlled circumstances.