Nursing care
Tracheostomy tube dislodged: oxygenate first, then decide who replaces it
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated October 2026
Short answer
When a tracheostomy tube comes out, the first priority is oxygenation, not the tube. The nurse calls for airway help, applies high-flow oxygen to both face and stoma and checks breathing. An established stoma may allow a trained nurse to insert the spare tube under local protocol, while a recent tracheostomy needs the airway team rather than repeated blind attempts.
Oxygen and help come before the tube
A dislodged tracheostomy tube is an airway emergency, but the instinct to push it straight back in can waste time or cause harm. The National Tracheostomy Safety Project algorithm begins by calling for airway expert help and checking whether the client is breathing. If they are, high-flow oxygen goes to both the face and the tracheostomy, because many clients can still move some air through the upper airway.
If the client is not breathing and has no pulse or signs of life, the resuscitation team is called and CPR starts. For a breathing client, the nurse looks, listens and feels at the mouth and stoma, watches saturation and colour, and keeps the client sitting up if that eases breathing. A partially displaced tube can look in place while sitting in the soft tissue, so poor air movement matters more than appearance.
Fresh stoma or established stoma
The age of the stoma changes what is safe. A recently formed tracheostomy has not yet healed into a stable tract, and patient information from Cleveland Clinic gives about two weeks for full healing; local policy defines when a stoma counts as established. In a fresh stoma the tissue planes can close or misdirect a tube, so an inexperienced rescuer may push it into the tissues of the neck rather than the trachea. Reinsertion here belongs to the airway or surgical team.
With an established stoma, the tract is more defined. Clients at home are taught to keep a spare tube and to replace a tube that falls out, calling emergency services if they cannot. In hospital, a nurse trained in tube changes may insert the spare tube, usually with its obturator, if local policy allows and breathing is not improving. Check the bedside sign and the documented date of the tracheostomy before acting, because those details tell the nurse which route is safe and who should attempt reinsertion.
What to do if breathing does not improve
If oxygen alone does not stabilise the client, the algorithm moves to primary emergency oxygenation. Through the mouth, rescuers use standard airway manoeuvres with the stoma covered, a bag-valve-mask, or airway adjuncts. Through the stoma, a small or paediatric face mask, or a supraglottic device such as a laryngeal mask, can be applied over the opening to deliver breaths.
Secondary steps include oral intubation or intubating the stoma with a small tracheostomy or endotracheal tube, which are tasks for clinicians with advanced airway skills. Clients with a laryngectomy cannot be oxygenated through the mouth at all because the upper airway is disconnected, which is why bedside signs that identify the airway type matter in an emergency. Throughout these steps the nurse keeps reassessing breathing, saturation and colour, and records each action and its time so the arriving team knows what has already been tried.
Prioritise in a hypothetical scenario
Picture a hypothetical client who had a tracheostomy formed three days ago and coughs the tube out during repositioning. Saturation is falling and the client is anxious but breathing. Options include reinserting the original tube quickly, leaving the room to find the surgeon, suctioning through the open stoma, or calling for airway help while applying high-flow oxygen to face and stoma.
Calling for help and oxygenating both routes is the strongest answer. Blind reinsertion into a three-day-old stoma risks placing the tube outside the trachea, leaving the room abandons an unstable client, and suctioning without first oxygenating delays the priority. Cleaning the site and updating the care plan can wait, and an assistant can bring the emergency equipment while the nurse stays.
Sources and further reading
National Tracheostomy Safety Project: Adult emergency tracheostomy algorithm (patent upper airway). Call for airway help, high-flow oxygen to face and tracheostomy, patency checks, tube removal, primary oral and stoma oxygenation and secondary intubation steps.
National Tracheostomy Safety Project: Ventilation via the stoma. Oxygenation as the priority, stoma oxygen and paediatric mask or laryngeal mask over the stoma, and reinsertion as a specialist technique.
MedlinePlus: Tracheostomy care. Carrying a spare tube and calling emergency services if the tube falls out and cannot be replaced.
Cleveland Clinic: Tracheostomy. A tracheostomy takes about two weeks to fully heal and tube displacement needs prompt attention.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our respiratory practice questions are the closest set to what this page covers.
Common questions
What equipment should be at the bedside of a client with a tracheostomy?
A spare tube of the same size and one size smaller, the obturator, suction, oxygen and a bag-valve-mask are typical, along with the bedside sign describing the airway. Exact lists follow local policy, so check them at the start of every shift.
Should the nurse ever reinsert a tracheostomy tube?
In an established stoma, a nurse trained in tube changes may do so under local policy. In a fresh tracheostomy or if insertion is difficult, the nurse oxygenates and waits for the airway team rather than forcing a tube.
Why does oxygen go to the face as well as the stoma?
Many clients with a tracheostomy still have a connection between the upper airway and lungs, so oxygen via the face can reach the lungs. Clients with a laryngectomy are the exception and can only be oxygenated through the stoma.