Tracheostomy tubes are a standard in modern medical care, and provide the opportunity for patients to survive and thrive who could not do so without the procedure. But the tubes can become dislodged, either through the breathing process itself, simple movements, or the moving and rolling of the patient by medical staff and other caregivers. When a tube is dislodged, the result can be serious brain injury or death.
Dislodged tubes occur much more frequently in patients whose tracheostomy was relatively recent. The problem occurs more often with larger or obese patients. Patients with thick necks are more likely to dislodge a tube. Other factors leading to dislodged tracheostomy tubes include:
- Low stoma placement
- High patient movement
- Loose tracheal ties
- Traction on ventilatory tubing
- Use of positive-pressure ventilation on non-compliant lungs
Failure to Timely Recognize Dislodged Tube
When a tube is dislodged, a nurse is generally the first responder. At the first sign of a possible dislodged tube, the nurse (or other caregiver) should send another individual to urgently summon a physician. A dislodged tube also calls for immediate attempts at manual ventilation, and suction with a solution of sodium chloride. This will rule out a mucus plug. Once this is done, to prevent brain damage the nurse should immediately deflate the tracheostomy cuff and take out the tracheostomy tube.
Further attempts at ventilation through the tube should be avoided. If the tube has become dislodged, air can be forced into surrounding soft tissue rather than the lungs, leading to a host of complications from tracheal compression to emphysema.
Moreover, if the tracheostomy is new, only a physician should reinsert the tube, and a nurse should never attempt to reposition the tube. This is because it takes time for the tract to form, and repositioning before the tract has formed can lead to complications as severe as those caused by the failure to act.
If a dislodged tube is not detected in a timely fashion, the patient can suffer an anoxic event – a severe form of oxygen deprivation leading to serious brain injuries.
Therefore, although a dislodged tracheostomy tube is generally not in and of itself a particularly damaging complication, the failure by medical staff to respond promptly to the problem can and does lead to permanent disability and death.
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