Assessment can be aided by using capnography or a Waters circuit.

Capnography can be mainstream (Fig 1) or side-stream (Fig 2). Capnography is increasingly available on resuscitation trolleys and should be immediately available in all areas where patients with tracheostomies are managed. Correct interpretation of the waveform is as important as having the equipment available.

Fig 3 is a video showing oxygen being attached to the face and neck. If you are trained to use a Waters circuit, then the bag can move with spontaneous respiration, giving a visual clue that the patient is breathing and that the tracheostomy tube is patent. Problems can occur with the valve on a Waters circuit if you aren’t familiar with one, so use one only if trained. Waveform capnography is the best way of determining airway patency.