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Evidence‐based approaches

Principles of care

Maintaining a patent artificial airway

When moving a patient with an artificial airway, it is important to maintain neutral head and neck alignment within the movement plane. It is sensible to have one member of staff in sole charge of looking after the patient's artificial airway to avoid risks of trauma, dislodgement and occlusion and, if the patient is ventilated, prolonged disconnection from the ventilatory and oxygen source. Changing position will also alter the neck musculature so it is important to ensure the tracheostomy tapes are tied securely before and after moving the patient.
With newly formed tracheostomies, there is an increased risk of dislodgement 7–10 days following the procedure as the surrounding fascia and muscle need to repair to form the tract (McGrath [71], NCEPOD [80]). During this time, it is important to have the following equipment by the patient's bedside and to display signage regarding the type of artificial airway and the emergency tracheostomy care algorithm (McGrath et al. [72]) (see Figure 12.35):
  • tracheal dilators
  • two spare tracheostomy tubes, one a size smaller than the one in situ
  • tracheostomy tapes
  • spare inner cannula
  • inner tube cleaners, oxygen supply and tracheostomy mask
  • humidification
  • suction equipment
  • bag‐valve mask
  • lubricant
  • stitch cutter.
These are essential in case the patient's airway is compromised (for guidance on how to use this equipment, see Chapter c12: Respiratory care, CPR and blood transfusion).

Emergency situations

The three most significant life‐threatening emergency situations with a tracheostomy tube are blockage, displacement and haemorrhage. If any of these occur while moving the patient, stop and call for assistance immediately.
Staff should not be moving a patient with a tracheostomy, particularly a new tracheostomy, unless they are experienced in managing these emergency situations or working alongside someone who is (NCEPOD [80]).
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