First, Don’t Panic…
| Introduction | The Essentials |
| Deep Cuts | What’s Next |
You walk into the room and someone shouts, “The trach came out!”
Your heart jumps. The patient is gasping. Oxygen sats are falling.
This is a high-stakes moment — and the clock is ticking.
The Core Essentials
What You Need To Know:
Let’s cut through the noise. These are the essentials. Want to go deeper? Scroll down to the Deep Cuts section. If you’re in one of our immersive pop-up spaces, hit the linked station for hands-on practice and next-level skills training. Let’s get started.
Accidental tracheostomy decannulation can turn catastrophic quickly, especially in a newly placed tracheostomy. However, with a straightforward and practiced approach, you can turn chaos into control. When you’re done with this learning space, you should be able to:
- Prioritize Oxygenation and assess breathing. Some patients maintain airflow via a stoma or upper airway.
- Know why it’s essential to check if the trach is mature (>7 days), reinsertion may be safe, but only by experienced hands.
- Be prepared to shift focus to the upper airway — mask ventilation, LMA, intubation.
- Be able to replace a trach tube — one at the neck, one at the face.
“The most common, and most commonly lethal, problem was displacement of the tracheostomy, especially on movement or in the obese patient, or both.” – NAP4 Study.
Accidental Decannulation: What to Do When the Tube Pops Out
👉 Click Here for Detailed Steps for Managing Decannulation
Start Here
Stop when the patient is stable.
1. Assess Breathing
- The patient may be breathing adequately via:
- The tracheostomy stoma, or
- The upper airway
- If so, no immediate action may be required
2. Consider Replacing Tracheostomy Tube
- If >7 days post initial insertion:
- Experienced staff can attempt to reinsert the tracheostomy tube
3. Upper Airway
- Manage the upper airway:
- Mask ventilate
- Laryngeal Mask Airway (LMA)
- Intubate
4. Upper Airway and Tracheostomy at the Same Time
- Airway team: manage the upper airway
- Neck team: manage access via tracheostomy stoma
Primary measures:- LMA or pediatric mask over the stoma
- Endotracheal or tracheostomy tube in the stoma
- Consider using::
- Traction on stay sutures
- Tracheal dilators
- Endotracheal tube on bronchoscope
- Bougie or exchange catheter
- Guidewire and Melker kit
5. New Surgical Airway
- Prepare for surgical airway if unable to re-establish airway via existing routes
How to Replace that Tube
You’ve determined you can and should replace that trach tube. You need to know how to do it. Here are a few key pointers and a rapid review video. For a more detailed review, head to our Deep Cuts section. Here are a few things to remember:
- Clean (Not Sterile) Technique:
- Hand Hygiene + Clean gloves
- Check Cuff for Leaks
- Lubricate the Tube
- Insert Obturator
- Insert Tube Into Trachea
- Confirm Placement & Secure
🎧 Deep Cuts
You’ve got the basics down—great work! To keep learning, head to the next poster. Want to go deeper? Click Continue the Journey for extra clinical pearls, evidence reviews, and curated links to expand your learning network—or bookmark it and return anytime.
Click Here for Deeper Cuts
🎸 Great! Welcome to the Deeper Cuts for this Topic
What Can Go Wrong? 👉 Take a look at this interesting case series and the consequences of accidental decannulation.
A fantastic 👉 blog post. from the Northwestern University Emergency Medicine department on accidental decannulation. It’s definitely worth exploring, and then adding them to your learning network.
And it comes with this great infographic!
CLEAN TECHNIQUE: TRACHEOSTOMY TUBE CHANGE QUICK CARD
WHEN TO USE:
- Mature tracheostomy tract (>7 days)
- Routine inpatient or home care tube changes
- Low-risk patients
PRE-PROCEDURE PREPARATION:
- Perform hand hygiene (alcohol-based hand rub or soap & water)
- Gather supplies:
- Clean tracheostomy tube (same size + one size smaller)
- Water-soluble lubricant
- Clean gloves (non-sterile)
- Clean trach ties or holder
- Suction equipment
- Bag-valve-mask (BVM)
- Oxygen source
- Backup airway equipment
- Clean work surface (wipe bedside table or tray)
PATIENT PREPARATION:
- Explain procedure (if patient awake)
- Position patient supine with neck slightly extended
- Apply oxygen and pulse oximetry
- Suction stoma and trach tube prior to removal
PROCEDURE STEPS:
- Apply clean gloves
- Loosen or remove old ties
- Deflate cuff completely (if applicable)
- Gently remove old tube along natural tract angle
- Insert lubricated new tube into existing tract
- Confirm placement:
- Chest rise
- Breath sounds
- Oximetry
- End-tidal CO2 (if available)
- Secure with new trach ties or holder
POST-PROCEDURE MONITORING:
- Observe for respiratory distress, bleeding, subcutaneous emphysema
- Verify ongoing oxygenation
- Document tube type, size, depth, and patient tolerance
SAFETY NOTES:
- If any resistance is felt during insertion: STOP, reassess
- Have full airway rescue equipment immediately available
Bottom Line
If the trach pops out, don’t panic — call for help, check the patient, and focus on oxygenation. That’s the mission. If the stoma is mature, you might reinsert it — but never force it. Think fast, act smart, and be ready to escalate. Oxygenation and airway always come first.
There’s a Hands-On Station Ahead
If you’re inside one of our immersive pop-up learning spaces—where audio, video, and hands-on interaction come together—don’t miss the nearby station. You’ll find anatomic models, airway devices, 3D-printed objects, and other tactile tools designed to deepen your understanding and bring this topic to life. Take a moment to engage. Touch. Try. Test. It’s all part of the experience.
What’s Next
Find Or Click Me
Nice work—you’re through this section! To keep going, scan the QR code on the physical poster at the next station in our pop-up training space to access the next set of digital content. Prefer to stay online? Just click the poster image here to continue your journey.
You must be logged in to post a comment.