Tracheostomy

What Is Decannulation?

The term “decannulation” refers to the removal of the tracheostomy tube from the neck and the stoma is allowed to close up and heal. This is usually a ‘planned’ procedure and done by a health care professional only when a patient can breathe unobstructed using their upper airway.

Emergency Decannulation is just what it implies; an emergency! A decannulation in this situation can happen for various reasons. Coughing too forcefully, a tumor encroachment, trach tie is too loose or comes undone or, in the case of children, rough play can pull a trach tube out of the neck.

Why is Decannulation an Emergency?

• Only unobstructed breathing route for most
• Stoma begins to close up immediately making it difficult to impossible to re-insert the current tube
• Forceful dislodgement of the tube can cause trauma to the airway or stoma
• If a patient is ventilator-dependent, they will have no way to breathe on the machine and this can be a life and death situation.

Tips for Emergency Decannulation

• Go immediately to your local emergency room, call 911 if necessary and explain the situation. Do not go to a walk-in clinic or your doctor’s office, they will not have the correct tube on hand nor the resources if your stoma needs to be re-opened.
• ALWAYS make sure your trach tie is secure. Rule of thumb is you should be able to slip a finger between your trach tie and your neck. If the tie is too loose, a forceful cough could can dislodge the tube.
• Have a trach tube in your style in one size smaller for emergency use. In other words, if you are using a Shiley size 6 tube, have a Shiley size 4 tube on hand in case of an emergency decannulation. Insertion of the smaller size will maintain the stoma open and keep a patent airway until doctors are able to put in proper size in the ED.
• Keep track of any changes in how the tube “sticks out from the neck”. If you notice that it seems to be protruding more than normal, there may be something pressing against it and pushing it out of place. If this situation arises, you will need to report this to your MD. This is especially important for any patient who suffers from neck or throat cancer or anyone who may have a tumor in the neck.

If your trach tube becomes dislodged for any reason, do not hesitate to go to the hospital as this is truly an emergency situation. The longer you wait to have it addressed, the more you are in danger of not being able to breathe. Remember, this is your unobstructed way of breathing and keeping you alive.