Tracheostomy red flags and managing emergencies

Like many clinical incidents, there are often warning signs that precede an emergency situation. Red flags are the often-detectable warning signs that occur before an emergency. Knowing what to look out for will help to prevent minor problems escalating.

We often see warning signs several hours before an incident.

Airway red flags

If the patient has a cuffed tracheostomy correctly sited in the trachea, no gas should escape through the mouth. If the patient is talking to you, or audible air leaks or bubbles of saliva are seen or heard at the mouth or nose, then gas is escaping past the cuff. This may imply that the cuff is damaged or the tube tip is not correctly sited. Grunting, snoring or stridor are also signs that there is an airway problem.

Breathing red flags

Carry out a full assessment of your patient’s breathing. Refer to earlier chapter on breathing. 

  • Is your patient breathing?

  • Look for signs that your patient is struggling to breath

  • Is there use of accessory muscles?

  • Increased respiratory rate?

  • Is the patient hypoxic? Monitor saturations

Specific Tracheostomy Red flags

Observe the Tracheostomy tube.

  • Are there any signs of tube displacement or deviation?

  • Can you see any blood or blood stained secretions around the tube?

  • Is the patient complaining of any pain at the site of the tracheostomy tube?

  • Any issues with the cuff. Is the cuff inflating?

Please watch the video on tracheostomy red flags:

Emergency management of a blocked tracheostomy tube

As a first responder in an emergency situation you will need to be able to safely manage a deteriorating patient with a potentially blocked tracheostomy tube.

Each bed space will have a blocked tracheostomy algorithm for you to utilise and follow to ensure you manage your patient appropriately.

Always ensure you call for help as soon as you suspect there us an issue and follow the first responder steps in the emergency algorithm above.

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Always ensure you call for help as soon as you suspect there us an issue and follow the first responder steps in the emergency algorithm above. -

Below is a video that demonstrates the management of a deteriorating patient with a blocked tracheostomy tube: