What to Do If Your Tracheostomy Tube Falls Out

A tracheostomy (or trach) tube connects to your windpipe through a hole in your neck (called a stoma). It helps move air in and out of your lungs if you can’t breathe through your nose and mouth.

You might need a trach tube because of an illness or injury that blocks the upper airway. Or you might need it because of a health condition that makes it hard to move air through your nose and mouth. You may only need a trach tube for a short time, or you may live with it permanently.

If you have a trach tube, it’s important to be prepared in case it becomes blocked or falls out. Share this information with any caregivers so they can support you. Consider these tips:

Ask the doctor or nurse to explain the parts of your trach tube to you. It’s important to understand what the different parts of your tube do and how they’re used. Most trach tubes consist of three main parts:

• An outer tube (or outer cannula) that holds the stoma open. A neck plate extends from the sides of the outer tube and has holes to attach cloth ties or a self-adhering strap around the neck.
• An inner tube (or inner cannula) that fits inside the outer tube. It has a lock to keep it from falling out, and you can remove it for cleaning. Some models don’t have a removable inner tube.
• An obturator to insert the trach tube. It fits inside the outer tube and helps guide it into place. Unlike the inner and outer tube, it is not a permanent part of the trach tube.

Practice changing your trach tube. After you get your tube, the doctor or nurse will show you and any caregivers how to change it. Practice changing your trach tube in a calm setting and when help is available. That way, you’ll feel more prepared to act in an emergency.

Keep spare parts and equipment for tube changes nearby. That way, you can access them quickly in an emergency. You may need:

• An outer tube in your current size.
• An outer tube one size smaller in case the usual size won’t go in easily.
• A clean inner tube (if your trach tube uses one).
• The obturator to help guide the tube into place.
• Cotton ties, tape, or hook-and-loop straps to secure the tube around your neck.
• Water-based lubricant to prevent the tube from sticking to the skin.
• A catheter or machine to suction mucus out of the airway, if needed.

Try to stay calm and alert a caregiver. It’s safest to have help from another person when inserting a trach tube. Then take these steps:

• Wash your hands if you have time.
• If you need oxygen to breathe, place an oxygen mask directly over the stoma. If you can get air through your upper airway, place the oxygen mask over your nose and mouth.
• Tilt your head back slightly.
• If the tube is still inserted part of the way, try to gently push it back into place. Don’t force it.
• If the tube fell out all the way, or if you cannot reinsert the old tube, gather the equipment for a tube change.
• Put the obturator in the new outer tube and put a few drops of lubricant or water on the end.
• Insert the new trach tube and quickly remove the obturator.
• Insert and lock the inner tube.
• Secure the new tube with tape or straps. Keep holding the tube in place until it’s safely fastened around the neck.
• If the tube won’t go in, try a smaller size. If you still can’t insert the tube, call 911.

If your trach tube falls out, call 911 right away if you:

• Are struggling to breathe.
• Haven’t been trained in how to change a trach tube, or if you have no one to help you.
• Can’t get the tube in.
• Have had your trach tube for less than 7 days. A fresh tracheotomy has not healed enough for you to safely insert a new tube.

Take these steps while waiting for help to arrive:

• Keep the stoma open. Tilt your head back. Gently spread the stoma opening with your fingers to allow air to move in and out of the lungs.
• Give oxygen. If you’re struggling to get air, use an oxygen mask over the stoma opening. If you can get air through your upper airway, place the oxygen mask over your nose and mouth.