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Tracheostomy Emergencies

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Haemorrhage

Tube Change Failure/Accidental Decannulation

Identification & Management of the Occluded Tracheostomy Tube

Resuscitaion of pateints with a Tracheostomy Tube

This is not an exhaustive list and staff must use clinical judgement to assess patients well being.

If there is ongoing concern regarding the patients condition they should be reviewed by a competent healthcare practitioner.  Care should be focused on minimising the risk to the patient. Early intervention and management may prevent a clinical emergency occurring.

  • Presence of respiratory distress
  • Increased respiratory rate
  • Increasing MEWS/SEWS
  • Increasing oxygen requirements
  • Decreased SaO2
  • Hypotension
  • Tachycardia
  • Decreased level of consciousness
  • Noisy breathing
  • Difficulty removing secretions either by suctioning or asking the patient to expectorate
  • Patient complains of shortness of breath
  • Ongoing concern or unresolved issues relating to the airway
Clinical assessment should include but not be limited to the identification of the following:
  • Is the tracheostomy tube patent?
  • If patent, give the patient high flow oxygen via the tracheostomy tube
  • Is the patient appropriately monitored ?
  • Is help coming ?
  • Look for the cause of the problem and where possible resolve these
Priorities for care

If a clinical emergency arises ensure the appropriate help is sought immediately. Throughout the algorithms the term “Seek Expert Help” refers to any member of the multidisciplinary team who is experienced in caring for the patient with a tracheostomy or who has advanced airway management skills. To achieve this it may be necessary to initiate a cardiac arrest call.

Care of the patient with tracheostomy is guided towards preventing clinical emergencies. Management will depend on the needs of the patient and the type of tracheostomy tube in situ. Quick reference guides should be available in clinical areas.