# Place the nurse's actions in priority order after accidental decannulation of a mature tracheostomy.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=396401&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

Place the nurse's actions in priority order after accidental decannulation of a mature tracheostomy.

Apply oxygen to the face and stoma while assessing breathing, oxygen saturation, airflow, and the stoma.

If trained and oxygenation permits, gently insert the same-size spare tracheostomy tube with its obturator through the mature stoma, then remove the obturator.

If the same-size tube meets resistance, stop rather than force it and attempt the one-size-smaller spare tube while expert help continues airway support.

Confirm ventilation with airflow or capnography, breath sounds, chest movement, and improving oxygen saturation, then secure the tube.

Stay with the client, call expert airway or emergency help, and bring the bedside tracheostomy emergency equipment.

## Explanation

Accidental decannulation is an airway emergency. Call for expert help and oxygenate through both potential airways while rapidly assessing the client. In a confirmed mature stoma, a trained clinician may gently replace the same-size tube and then try one size smaller if needed; forcing the tube risks a false passage. Confirm ventilation before securing the replacement.

## In-depth explanation

Correct sequence
Call help → oxygenate and assess → same-size tube if trained → smaller tube if needed → confirm ventilation and secure.

Why this is correct
The age and type of the stoma and whether the upper airway is patent change the rescue plan. A mature, clearly identified tract is more suitable for trained replacement than a fresh tract, but resistance still raises concern for a false passage. Oxygenation and expert airway support take priority over repeated blind attempts.

NCLEX decision rule
Read the bedside airway information first. Never force a replacement, and do not assume a tracheostomy patient can be oxygenated only through the neck unless the client is a laryngectomy or the upper airway is known to be nonpatent.References
1National Tracheostomy Safety Project adult emergency guidelines
2AARC adult tracheostomy clinical practice guideline

## Clinical scenario

Tracheostomy airway emergency
The tracheostomy was placed 3 weeks ago and the bedside sign confirms a patent upper airway and a mature stoma. The client is anxious and dyspneic. Follow the facility's tracheostomy emergency algorithm and attempt tube replacement only if trained.

## Key concepts

- **Accidental Decannulation** — Unplanned displacement or removal of a tracheostomy tube from the tracheal stoma.
- **False Passage** — Placement of a tube into tissue outside the tracheal lumen, which can prevent ventilation and cause injury.
- **Decannulation** — Accidental or planned removal of a tracheostomy tube.

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