Download SECTION 13: EMERGENCIES: Accidental Extubation

Emergencies – Accidental Extubation
Strength of Evidence Level: 3
SECTION: 13.01
__RN__LPN/LVN__HHA
PURPOSE:
To provide an emergency tracheal airway for ventilation
and oxygenation of tissues.
b.
CONSIDERATIONS:
1. Accidental extubation is a medical emergency. A
second sterile tracheostomy tube should always be
available.
2. Do not leave the patient until a patent airway or
emergency medical care is obtained.
3. Prevent accidental extubation by using a secure
knot on tracheostomy ties.
4. Tracheostomy tube change can be routinely
performed safely in the home. (See Respiratory
Procedure: Tracheostomy Care - Tube Change.) In
case of accidental extubation, there may not be
enough time to perform all steps of the routine
procedure since time will be of the essence.
c.
(10) Apply tracheostomy bib.
(11) Suction patient, if necessary.
If no tracheostomy tube is available:
(1) Hold open tracheal opening with a
hemostat.
(2) Obtain emergency medical assistance.
(3) Notify physician.
If patient cannot breathe on his/her own, and
airway cannot be opened with hemostat or
cannula reinsertion within 30 seconds:
(1) Close tracheostomy stoma with thumb and
fingers using 4x4 gauze, if available.
(2) Initiate cardiopulmonary resuscitation or
ventilate patient with hand-held
resuscitation 12 times per minute.
(3) Obtain emergency medical assistance.
(4) Notify physician.
AFTER CARE:
1. Document in patient's record:
a. Incident, time and any contributing factors.
b. Treatment provided.
c. Patient's response to treatment.
d. Notification of physician.
EQUIPMENT:
Sterile tracheostomy tube or expelled tube
Hemostat
Water-soluble lubricant
Hand-held resuscitator (optional)
Twill ties
Scissors
4 x 4 gauze tracheostomy dressing
5 mL syringe
Stethoscope
Gloves
PROCEDURE:
1. Adhere to Standard Precautions.
2. Explain procedure to patient.
3. Provide the patient with a patent airway by any of
the following:
a. Insert the sterile tube or reinsert the expelled
tube by:
(1) Inserting obturator into the outer cannula of
tracheostomy tube.
(2) Lubricating outer cannula with sterile watersoluble lubricant.
(3) Insert tube using an upward, curved
motion.
(4) Remove obturator when tube is in place.
(5) Insert inner cannula into tracheostomy plate
and turn until it locks into place. Hold
tracheostomy plate firmly into place in case
patient coughs or gags during this process.
(6) Reinflate cuff if tube is cuffed.
(7) Check tube for air exchange by observation
or auscultation.
(8) If indicated, connect patient to ventilator or
resuscitator.
(9) Apply and secure twill ties.
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