Decannulation 

A tracheostomy should be removed as soon as it is no longer required.

Once your patient has successfully completed all the above stages, we can then think about taking out the tracheostomy tube (decannulation). This is always a multidisciplinary decision.

Indication for decannulation

1. The initial reason for the tracheostomy has been resolved

2. The patient can tolerate cuff down and capping for 4 hours as above

3. The patient has a strong cough and can expectorate their secretions

4. MDT in agreement that decannulation is suitable in the context of the overall medical picture

5. The patient is clinically stable

The following video demonstrates how to perform a decannulation:

A controlled decannulation means that the removal of the tracheosotmy tube takes place with the additional support of the an airway trained doctor (e.g the Critical care outreach team). A controlled decannulation is required, if for some reason your patient deviates from the standard weaning pathway but all members of the MDT are in agreement that the patient may be suitable for a controlled decannulation. This is discussed and documented and arranged in a safe environment with the support of the iMobile team.

Post Decannulation Care

Once the tracheostomy tube has been removed, the stoma site should be cleaned with 0.9% sodium chloride and dried, and an occlusive dressing applied.  The dressing should be changed daily  and observe the site for signs of infection. 

Encourage your patient to press on the dressing directly over the stoma when talking or coughing to occlude the stoma fully and reduce expired air passing through the stoma, enabling the patient to have a stronger voice and cough, and help the stoma to heal.

The patient is closely monitored to ensure they are able to maintain their own airway without the tracheostomy tube. In the event of failed decannulation, a plan needs to be arranged to ensure the patient can be safely managed, should the tracheostomy need to be reinserted.