There are a number of sequential steps to work through to diagnose and treat the common causes of tracheostomy tube problems.

The first step is to remove anything attached to or blocking the end of the tracheostomy tube. Such as:

• Speaking valves, which are:
  • Blocked with secretions
  • Used incorrectly with the cuff inflated
• Obturator caps, which may be used as a trial to see if a patient can manage without the tracheostomy
• Humidifying devices, such as heat and moisture exchangers (HMEs) or Swedish noses, may be blocked with secretions

Fig 1 is a video of a speaking valve being removed.