A tracheostomised patient suddenly becomes hypoxic with high airway pressures. Suction catheter will not pass through the tube. What is the immediate airway action?
Failure to pass suction suggests obstruction or displacement. The NTSP approach prioritises oxygenation, removal of simple obstructions, tube removal when ineffective, and assessment of both face and stoma while summoning expert help.
A. Keep ventilating forcefully through the blocked tube: This can worsen surgical emphysema or barotrauma and does not restore patency.
B. Wait for a chest radiograph: Imaging must not delay emergency oxygenation and airway opening.
C. Insert a new tube blindly before removing the old one: Blind manipulation risks a false passage, especially in a fresh tract.
D. Remove the inner cannula and, if obstruction persists, remove the tracheostomy tube while oxygenating both potential airways: Failure to pass suction suggests obstruction or displacement. The NTSP approach prioritises oxygenation, removal of simple obstructions, tube removal when ineffective, and assessment of both face and stoma while summoning expert help.
E. Occlude the mouth and nose permanently: Both upper airway and stoma should be considered until laryngectomy status or upper-airway patency is known.
If the patient had a total laryngectomy, oxygen and ventilation must be delivered via the stoma because there is no connection to the mouth or nose.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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