Tracheostomy — safety
At the bedside at all times: a spare tube of the same size, a tube one size smaller, an obturator, a manual resuscitation bag, suction equipment. Suction only on withdrawal, 10 to 15 seconds per pass, preoxygenate, allow recovery between passes. Accidental decannulation: stay with the person, call for help, and reinsert with the obturator if you are trained and the stoma is mature. A fresh stoma, under seven days, can close within minutes. The person cannot speak with a cuffed tube: provide a call bell within reach and a way to write.