Tracheostomy Emergencies: Dislodged & Obturator Trach

A tracheostomy (or “trach”) is a procedure in which an incision is made through the neck and into the windpipe (trachea). A tube connected to ventilation equipment or supplemental oxygen may be inserted during a tracheostomy. 

Typically, healthcare providers perform this procedure when airway obstructions prevent adequate airflow. It can also help drain fluid from the lungs and allow suctioning of secretions. Despite its benefits, various complications associated with tracheostomies can make them dangerous for patients if not followed up properly. 

In some cases, even when nurses and physicians take all necessary precautions, problems such as dislodged trachs do occur. Read on to learn more about identifying symptoms related to tracheostomies and how best to avoid complications from these difficulties with careful health monitoring!

Symptoms

The most common symptoms of a trach complication include:

• coughing
• fever
• chest pain
• difficulty breathing.

A patient may also experience an increase or decrease in secretions from the trach tube. In severe tracheostomy complications, respiratory distress can occur due to blockages or air leakage through the opening. If any such signs are present, medical attention should be sought immediately.

Complications

Complications related to tracheostomies can be life-threatening if not addressed promptly and adequately. Some common issues that may arise include:

• infection
• bleeding
• granulomas (small growths caused by irritation)
• problems with cuff inflation/deflation
• tube misalignment
• dislodged tubes.

Dislodged tubes can be particularly problematic, as they can cause the tracheal opening to close off and restrict airflow. Luckily, specific strategies help mitigate this risk.

Equipment Used

• Routine tracheostomy personal protective equipment (PPE)
• Clean gloves
• Safety shield, goggles, or glasses
• Disposable apron
• Surgical mask
• Tracheal dilators, for use by trained staff only
• 10ml syringe
• The spare tracheostomy tubes of the same size and one size smaller
• Lubricant
• Clean gloves
• Suction catheters
• Bag-Valve-Mask with both a face mask and tracheostomy swivel connector
• Pulse oximeter
• Stethoscope
• Cuff manometer

What to Do If a Trach Is Dislodged?

When a tube is dislodged, it needs to be dealt with immediately. Caregivers should use a sodium chloride solution for suctioning, which the doctor usually explains during tracheostomy.

This removes any mucus plugs and prevents brain damage. After deflation of the cuff, the tracheostomy tube should be taken out. It is not recommended to try ventilating through the tube again as this can push air into surrounding tissues instead of the lungs, causing complications.

If it’s a new tracheostomy, only a doctor should attempt reinsertion; therefore, medical attention is necessary.

The following vital steps may be followed to ensure the patient remains oxygenated:

• The patient should be carefully positioned with their chin pointing upward and neck extended.
• If there is difficulty in reinserting an old tracheostomy tube, the caregiver can try a smaller one. It is paramount to seek medical advice when airway security has been established.
• A suction catheter may also be inserted in the stoma to remove mucus plugs or any excessive secretions.
• Oxygen administration may also be necessary if prescribed by the patient’s doctor.
• Once these steps are taken, it is recommended to take the patient to the ER or doctor who initially performed the tracheostomy procedure as soon as possible for further assessment and care.

Dislodged trachs can be gently replaced by trained staff using a tracheal dilator. If the patient cannot tolerate the procedure, medical staff can administer a sedative to make them more comfortable. It is also essential that the trach size be checked to ensure that an appropriately sized tube is used for replacement. If the trach size changes, a larger or smaller tube may be necessary to ensure proper ventilation.

Tracheostomy Emergencies

In some cases, tracheostomy-related emergencies can occur. It is essential to be aware of the signs and seek immediate medical attention if any of the following occur:

• uncontrollable bleeding from the trach site
• fever above 101°F
• severe chest pain or difficulty breathing
• swelling around the tracheal opening.

These signs may indicate infection or other complications and should be evaluated by a physician as soon as possible.

Overall, tracheostomies can provide life-saving benefits for those who need them. With careful monitoring and quick intervention when necessary, most patients with trachs can live without fear of serious complications. It is essential to familiarize yourself with the warning signs and strategies for avoiding dislodged trachs, as this can help ensure a safe and healthy recovery.

Tracheostomy Emergencies: Occlusion

Occlusion of the tracheostomy tube is a serious and potentially life-threatening complication that can occur if the tube becomes blocked. When this happens, the patient cannot breathe properly and may develop respiratory distress or even cardiac arrest.

To prevent occlusion, healthcare professionals must check the tube frequently and ensure no kinks, blockages, or secretions around the tube. It is also essential to ensure that the patient’s neck brace is secure and not impeding airflow through the tracheal opening. If an occlusion occurs, seeking medical attention immediately for proper treatment is essential.

What is an Obturator Trach Emergency?

In a trach obturator emergency, the patient should be laid supine with the head tilted back, and neck extended slightly. An airway exchange catheter should be inserted into the tracheostomy tube to ensure an open airway, followed by reinsertion of the obturator. If this is unsuccessful, an emergency tracheostomy may be necessary. A healthcare provider should be contacted immediately for assessment and treatment.

Why does the Trach get Dislodged?

The tracheostomy tube may get dislodged due to the following reasons:

1. Accidental or intentional pulling on the tracheostomy tube: This can be done by either the patient, a family member, or a health care professional. Pulling on the tube may cause the tube to move and become dislodged.

2. Coughing, sneezing, straining, or vomiting: These activities can pressure the tracheostomy tube and cause it to dislodge.

3. Swelling or irritation of the tissue surrounding the tracheostomy: This can occur due to infection, skin breakdown, allergies, trauma or other inflammatory conditions. Swelling or inflammation can narrow the area where the tube sits and make it more likely for the tube to become dislodged.

4. Movement of the patient’s neck: This can cause the tracheostomy tube to move and become dislodged.

5. Unsecured tracheostomy ties: If the ties securing the tube in place are not secure, it could make it easier for the tube to dislodge.

It is essential for healthcare professionals and caregivers to constantly monitor the tracheostomy tube for any signs of dislodgement to prevent serious complications. If you suspect your tracheostomy tube may have become dislodged, it is essential to seek medical help immediately.

Certain factors enhance the risk of dislodgement of the tube; these include:

• A relatively recently performed tracheostomy
• Larger or obese patients
• Patients with large neck muscles or those who have difficulty lying still.
• Low tracheostomy placement
• High patient movement
• Loose tracheal ties
• Traction on ventilatory tubing
• Use of positive-pressure ventilation

What to do if the Tracheostomy is Accidentally Removed?

If the tracheostomy tube is accidentally removed, it should be replaced as quickly as possible with a new one of the same size and type.

In addition to replacing the tube, monitoring the patient’s vital signs (heart rate, blood pressure, oxygen saturation levels) and administering oxygen if necessary.

If the tracheostomy tube cannot be replaced or the patient cannot tolerate a new tube, a temporary airway should be established using an endotracheal tube. In this case, medical help should be sought immediately.

It is also essential to ensure that the ties used to secure the tracheostomy tube are not too tight and that the neck brace is secure and not impeding airflow through the tracheal opening. This can help reduce the risk of accidental removal.

To prevent the accidental removal of tracheostomy tubes, healthcare providers should remain vigilant and regularly check the tube for proper placement and security. It is also essential that a patient’s caretakers understand how to monitor the tube for signs of displacement or blockage. If any concerns are noted, medical attention should be sought immediately.

What are the pre-procedure guidelines I should follow for tracheostomy?

Before undergoing tracheostomy surgery, it is essential to inform the doctor about any medication being taken. Medicine may need to be changed or stopped for a few days prior, and fasting should occur for up to 12 hours.

What post-operative guidelines must I follow after undergoing a tracheostomy procedure?

The post-operative guidelines for tracheostomy include:

• Keeping the incision area clean and dry.
• Changing any dressings or gauze as directed by the doctor.
• Drinking plenty of fluids to stay hydrated and help flush out secretions.
• Taking medications, the doctor prescribes, such as antibiotics, painkillers, and topical ointments to promote healing.
• Practicing deep breathing exercises to help clear mucus from your airway.
• Avoiding activities that could strain the tracheostomy tube, such as heavy lifting or vigorous exercise.
• Contacting the doctor with any questions or concerns about post-operative care.
• Scheduling regular appointments with the doctor to monitor healing and check for any complications.

What is the recovery period after undergoing a tracheostomy procedure? 

The tracheostomy typically takes 10-14 days to heal, after which a fresh tube will be placed. Your throat and neck may feel tender during the healing period. During this time, you must become accustomed to breathing via the tube and eating, speaking, and other aspects of life with a tracheostomy.

Final Words

Tracheostomy tubes can be a vital tool for those who require them. With proper monitoring and quick action when necessary, most patients can go on to live healthy and everyday lives with their traches. It is essential to be aware of the warning signs of dislodgement or infection so that appropriate steps can be taken quickly to avoid serious complications. Healthcare providers can ensure patients receive the best care possible by understanding what to do in a tracheostomy emergency.