LEVEL: Paramedic

This procedure may be performed on any patient that has A TRACHEOSTOMY TUBE and WHO HAS:
A.  Hypoxia
B.  Respiratory arrest/failure
C.  Obtundation
D.  Secretions unable to be cleared by suctioning

Contraindications:  None

Key procedural considerations:
A.  If the patient or family has a replacement tube available, it may be used. If a replacement tube is not available, an endotracheal tube of a similar outer diameter may be used.
B.  Premoisten the tube with water soluble lubricant.
C.  Extend the neck and, if necessary, place a roll between the patient’s shoulder blades to aid in visualizing the stoma.D. If the tube cannot be placed easily, withdraw the tube; administer oxygen and positive pressure ventilation. NEVER force the tube.
E.  Secure the device to the patient.
F.  If the tube cannot be easily placed, a suction catheter may be used as a guide.