Tracheostomy dislodgement

Background

Tracheostomy Sizes

(1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea (A) Cricothyrotomy site (B) Tracheotomy site

Tracheotomy in situ
1 – Vocal folds
2 – Thyroid cartilage
3 – Cricoid cartilage
4 – Tracheal rings
5 – Balloon cuff

Shiley™ trach tube

• Average size:
  • Adult: 5-10mm
  • Peds: 2.5-6.5mm

Tracheostomy vs laryngectomy

It is important to differentiate between tracheostomy vs laryngectomy

• If laryngectomy:
  • The stoma is the only way to ventilate the patient.
  • Patient cannot be orally intubated

Differential Diagnosis

Tracheostomy complications

• Tracheostomy obstruction
• Tracheostomy dislodgement
• Tracheostomy infection
• Tracheostomy bleeding

Evaluation

• Determine whether tube is dislodged from the trachea, but not from the neck
  • Does a suction catheter pass without difficulty? If not, remove the tube

Management

• If fresh tracheostomy, may be able to pull at stay sutures to bring airway anterior
• BVM and look for bubbling at tracheostomy site