Originally published on July 23, 2011
B.L. asks, “How does tracheostomy dislodgement happen?”
Answer: Dislodgement can be one of the most serious complications of having a tracheostomy. Dislodgement can be even more serious than complete decannulation; because when the tube is completely removed from the stoma (decannulation), the problem is clearly visible. However, when the tube is dislodged, it may not be so obvious. In this case, the tube is still in the neck; however, the tip of the tube is not within the trachea and instead is positioned within the tissue anterior to the trachea, most often called a false passage.
Numerous attempts to replace the tube can enlarge the false passage, making subsequent attempts to replace it nearly always unsuccessful.
There are several risk factors for tracheostomy dislodgement: a tube that is too short, traction against the tube, edema of the neck, obesity or a thick neck, and excessive coughing or agitation.
Specific techniques of tube replacement depend on the maturity of the stoma and whether or not the patient is able to breathe around the tube. These are discussed in more detail in our recent article in the “The Dreaded False Passage: Management of Tracheostomy Tube Dislodgement”, Morris & Afifi, Journal of Emergency Medicine, 33(8).