Post-decannulation

Following the removal of the tracheostomy tube, the patient is left with an opening into the trachea. An airtight dressing is required to prevent the ongoing passage of air through the tract (tracheo-cutaneous fistula) which will delay wound healing.

The patient should be encouraged to apply gentle pressure to the dressing whilst coughing or speaking.

The wound should be airtight within two weeks and if not, then a referral to an appropriate surgical team should be made.

The use of a standardised weaning procedure should reduce the risk of patients 'failing' a decannulation attempt. However, a patient’s condition can alter which may necessitate re-insertion.

Question: What factors influence the method of re-insertion in this circumstance?

Answer

Answer: Factors influencing the method of re-insertion include:

Type and duration of original tracheostomy	A surgical stoma usually closes up more slowly than a percutaneous stoma An established stoma (more than a few weeks) also heals more slowly than a percutaneous stoma
Time since decannulation	The longer the period without the tube, the more likely the stoma is to close
Clinical urgency	If rapid ventilatory support or airway control is required then conventional upper airway management may be more appropriate
Skills and equipment available	Replacement can be as straightforward as inserting a new tube with a tapered introducer through to complex airway management under anaesthesia