Tracheostomy emergencies

[zzyzx]

I just read an article that stated that if an immature trach; ie one less than a week old, is dislodged, then it is unlikely that it can be replaced. However the article doesn't clarify if this is immediate or after say 15 minutes. Anyone have experience with this? Will the tissues around the stoma immediately collapse as soon as the tube is removed?

I would also like to hear anyone's experiences with other trach emergencies

[offlabel]

Really important to speak with the ENT surgeons about emergencies like this. A lot of what you do at the bedside will depend on what they've done in the OR and why they've done it.

First off, the danger of replacing a dislodged trach tube in this situation is that a false lumen can be created and ventilation will go into the paratracheal space, not the lungs. It isn't a mature stoma (which takes at least a week) and the competency between the skin and the trachea is being maintained by the tube.

If there are stay sutures, they can be used to elevate the trachea to the stoma to a tube can be placed correctly, but the bedside RN needs to know they are there and what they're for and how to use them.

If the trach tube is lost in a ventilator dependent patient, mask ventilation is the first course of action, assuming that the trach was not placed for upper airway trauma or surgery. You'd just have someone put a gloved hand over the stoma while someone hand ventilated and surgical and anesthesia help was on the way.

Careful oral intubation would be next, and the stay sutures would help with that too, if they were there, and, again, assuming that there wasn't an issue with the upper airway.

Last resort would be a non ENT or anesthesia person attempting to replace a tube into the stoma unless they had good experience with it.

[zzyzx]

Thanks for your reply. What would you do in this scenario: a vent-dependant patient is 3 days post trach placement, and while turning him his trach becomes fully dislodged somehow. Would it be incorrect to make at least one attempt and replacing it? Wouldn't you know if you the track was improperly placed if, after replacing it, you got poor compliance when bagging the trach?

[offlabel]

I'd call a code and try mask ventilation first. The worse thing that could happen is you think you're in and you're not. You might also disrupt anatomy for when ENT shows up, making things harder for them.

As a last resort, life or death thing, you could try, but only after you tried mask ventilation.