In a clogged tracheostomy tube, which is the final step in management?

• A. Clearing of the tube and re-insertion, for those whose tracheostomy tube is noted to be plugged
• B. Wipe neck opening with gauze
• C. Attempt to suction tracheostomy tube
• D. Remove tracheostomy tube if necessary

Answer: (D)

When a tracheostomy tube is clogged, airflow through the tube is blocked, so restoring ventilation is the priority. You would first try to clear the obstruction by suctioning and attempting to pass a suction catheter to assess patency. If those attempts fail to restore ventilation, the necessary next move is to remove the tracheostomy tube. Removing the tube clears the blocked airway and allows you to re-establish the airway with a new tube or another airway method as needed. Wiping the neck opening does not address the blockage, and simply suctioning or clearing without ultimately addressing a nonpatent tube is insufficient if airflow cannot be restored.