Accidental Decannulation

Definition
The tracheostomy tube may accidently be partially or completely out of the tracheal stoma.

 

 

Cause	Prevention
Child moving during trach tie changes	Use two people during trach tie changes Swaddle child during trach tie changes
Loose trach ties	Frequently check ties to ensure you can get only one finger between the ties and the child's neck
Short length of trach tube (usually neonatal tubes)	Consult with physician to determine if a longer trach tube can be used
Respiratory equipment pulling on trach tube	Secure respiratory equipment to child with a chest strap or secure to child's clothing
Child removes tracheostomy tube	Monitor child closely

Signs & Symptoms

Increased heart rate Change in skin color – pale or cyanotic Increased work of breathing- retractions or nasal flaring Level of consciousness – restlessness to unconscious Alarms of cardio respiratory monitor – high heart rate, low heart rate, apnea Decreased oxygen saturation as measured by an oximeter Low pressure alarm if volume ventilated Trach tub partially or totally out of the stoma

 

Intervention

Assess child’s status and hyperextend the child’s neck to gain access to the trach site Establish a patent airway If partially out, put tube back in stoma and tighten ties If completely out, insert the spare tracheostomy tube. Provide manual ventilation as necessary Proceed with CPR as indicated.

• Knowing the child's baseline will allow the nurse to better assess when there is a potential airway problem
• The emergency bag or “go-bag” has the equipment needed for problems with the tracheostomy and should be with the child at all times
• Keep up your skills in tracheostomy tube changes by participating in a change every 6 months; review the steps for emergency interventions for decannulation.
• The decision to call 911 for additional assistance is dependent on the child’s status. The primary value of emergency personnel is for additional assistance and transport to the nearest emergency department. Remember to take the “Go Bag” if the child is transported.