Decannulation of Tracheostomy

Definition:
The process whereby a tracheostomy tube is removed once patient no longer needs it.

Indication:
When the initial indication for a tracheostomy no longer exists.

Requirements:

A patient is considered a candidate for decannulation once the following conditions are met.

1.     Patient is alert and oriented and responsive to commands.

2.     Patient is no longer dependent on a ventilator for assisted breathing.

3.     The frequency requirement for tracheal suctioning is less than once a day. (This is not always the case. Check with your physician)

4.     Patient has met the criteria for decannulation outlined below.

Criteria for decannulation

1.     Patient should not be dependent on a ventilator.

2.     Patient’s mental status should be to the level of alert and responsive and should be able to manage their oral secretions without a risk of aspiration.

3.     Should not require frequent suctioning for tracheal secretions.

4.     Patient should be able to cough and clean his/ her tracheal secretions.

5.     The patient should have their tracheostomy tube downsized to a size 4 Shiley or similar tracheostomy tube and they should not have breathing difficulty in the presence of this tube.

6.     The size 4 Shiley or similar tube should be occluded (with a trach plug/ cork) for twelve hours during the day with close monitoring by the nursing staff  with no evidence of respiratory difficulty or requiring of suctioning of the trach tube.

7.     Once the patient is seen to tolerate the steps in item # 6 above, their trach is plugged for twenty four hours and they are monitored for respiratory difficulty or suction requirement.

Decannulation:

Once all of the above criteria are met, the patient is informed that their trach tube is going to be removed. They are instructed that they may experience a sensation of shortness of breath for a few minutes once they are decannulated.

Arrangements should be made for back-up personnel (RT or RN) to be available in case of emergency. Decannulation is usually not done at home.

The patient is placed supine (flat) on their bed, the tube is removed and the opening into the neck is covered with sterile gauze and a tape is placed over the gauze.

The patient is instructed to occlude the gauze with their finger tip every time they cough or speak so that air does not leak. They should change the gauze and the tape at least once a day (more often as needed) until the hole in the neck heals itself closed over the next few days to weeks. In a minority of patients (<10 %), the opening into the neck skin has to be surgically closed.