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Figure 3
Tracheostomy tube is placed anterior to trachea within a false passage.
Complete healing of the stoma typically takes approximately 1 week, and the stoma can quickly collapse if the tube is dislodged or inadvertently removed before that time. Dislodgement of the tracheal tube during the first postoperative week is considered a medical emergency; therefore, tube security is a priority. If a tracheostomy tube is inadvertently dislodged shortly after surgery, the tissue planes are likely to collapse, making simple replacement of the tube impossible.44,45 If a tube is dislodged, supplies, including suctioning equipment, a new tracheostomy tube with obturator, oxygen, and equipment for inserting an endotracheal tube, should be readily available at the bedside to manage the situation.23
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.