There are occasional problems in the removal of a tracheotomy tube and its replacement. Excellent textbook accounts1,2 describe the surgical procedure itself. Instruments exist for ensuring safety and maintenance of the tracheotomy tract, eg, the two-pronged or the three-pronged dilator.
Apparently, only oral tradition transmits the risks, technique, and occasional rare tragedy that results from the collapse of the trachea during replacement. If supraglottic or glottic obstruction is still present, there remains a serious challenge to respiration.
The following describes method and available instrumental help for continued guarantee of the airway without loss of a single breath (Figs 1 through 6). A polyethylene tubing section of appropriate diameter cut from a nasogastric tube is adequate for all adult sizes. It is cut twice the length of the tracheotomy tube residing in the trachea.
Technique.—The inner tracheal cannula is removed. This is replaced by the nasogastric tube segment, which
LEWY RB. Increased Safety in Tracheotomy Tube Replacement. Arch Otolaryngol. 1982;108(5):327. doi:10.1001/archotol.1982.00790530063016
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