# Situation: A 55-year-old man is on the surgical ward 3 days after a tracheostomy was created for prolonged mechanical ventilation. He now breathes on his own through a cuffed tracheostomy tube with a removable inner cannula and receives humidified oxygen at 35% by tracheostomy collar. His oxygen saturation by pulse oximetry has been 95% to 97%. Which equipment for emergency tube replacement should the nurse keep at his bedside at all times?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629783  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 55-year-old man is on the surgical ward 3 days after a tracheostomy was created for prolonged mechanical ventilation. He now breathes on his own through a cuffed tracheostomy tube with a removable inner cannula and receives humidified oxygen at 35% by tracheostomy collar. His oxygen saturation by pulse oximetry has been 95% to 97%.

Which equipment for emergency tube replacement should the nurse keep at his bedside at all times?

## 보기

1. The obturator plus spare tubes of the same size and one size smaller **✔ 정답**
2. The obturator plus spare tubes of the same size and one size larger
3. A spare tube of the same size, with the obturator in the supply room
4. A spare inner cannula plus normal saline for instillation

**정답: 1**

## 해설

A new stoma can close quickly and its tract is not yet formed, so the obturator (which guides reinsertion) and spare tubes of the same size and one size smaller must be at the bedside. The smaller tube can be inserted if the stoma has begun to narrow.

## 심화 해설

Why the bedside emergency set must include the obturator and two tube sizes

A tracheostomy created only 3 days ago is still a fresh stoma. The tract between the skin and the trachea has not yet matured into a stable, fibrotic tunnel. If the tube is accidentally dislodged or pulled out, the soft tissue can collapse and the opening can narrow within minutes. This is why emergency replacement equipment cannot be stored down the hall or in a supply room; it must be immediately available at the bedside.

The obturator is a rounded, smooth-tipped guide that fits inside the tracheostomy tube during insertion. It converts the blunt, open end of the tube into a tapered introducer, which helps the tube slide through the stoma without catching on tissue or creating a false passage. Without the obturator, reinserting a tracheostomy tube into a fresh, partially collapsed stoma is difficult and can cause trauma or misplacement into the pretracheal space.

The bedside set should contain a spare tube of the same size and a spare tube one size smaller. The same-size tube is the first choice because it maintains the patient's current airway diameter and ventilation parameters. However, if the stoma has already begun to narrow or if edema has developed, a same-size tube may not pass. The smaller tube can be inserted when the stoma has started to close, buying time until the airway can be formally reassessed. A tube one size larger is not appropriate for emergency replacement because a fresh stoma is unlikely to accommodate a larger diameter, and forcing it could tear the tract or create a false passage.

Key point! The obturator and both spare tubes must be at the bedside together, not separated. If the obturator is kept in the supply room while the spare tube sits at the bedside, the nurse loses the tool needed for safe, atraumatic reinsertion during an emergency.

Watch out! A spare inner cannula and normal saline are useful for routine inner cannula care and secretion management, but they do not solve the problem of a dislodged or obstructed outer tube. In a fresh tracheostomy, the life-threatening emergency is loss of the outer tube and stomal closure, not a soiled inner cannula.

The emphasis on immediate bedside availability and the inclusion of a smaller backup tube reflects the broader principle that post-tracheostomy airway threats are time-sensitive and require equipment that anticipates stomal narrowing. Preparedness for a new stoma means assuming the tract will not behave like a mature, well-formed opening.

## 임상 시나리오

Fresh Tracheostomy Emergency KitBedside replacement essentials for a new stoma
A stoma only 3 days old has no mature tract, so it can collapse and narrow within minutes if the tube is dislodged. Replacement equipment must be immediately at the bedside, never in a supply room.

Keep the obturator with spare tubes of the same size and one size smaller. The obturator acts as a tapered guide to prevent false passage during reinsertion.

The same-size tube is first choice to maintain current airway diameter. The smaller tube is a backup for a stoma that has begun to narrow or become edematous.

CautionDo not use a larger tube for emergency replacement in a fresh stoma; it may not pass and can cause trauma or create a false passage.

## 핵심 개념

- **Obturator** — A rounded, smooth-tipped guide inserted into a tracheostomy tube to facilitate atraumatic insertion through the stoma.
- **Fresh stoma** — A newly created tracheostomy opening whose tract is not yet mature and can narrow or collapse rapidly if the tube is removed.
- **Tracheostomy tube** — A curved airway tube placed through a surgical opening in the trachea to maintain airway patency.
- **Inner cannula** — A removable liner within some tracheostomy tubes that can be cleaned or replaced without changing the entire tube.
- **False passage** — An unintended tissue tract created during tube insertion when the tube tip catches on tissue instead of entering the trachea.

## 같은 주제 문제

- [Situation: A 24-year-old woman with asthma is brought to the emergency room (ER) with whee…](https://mymerci.kr/pages/nclex_q.php?qn_id=629676)
- [Situation: A 24-year-old woman with asthma is brought to the emergency room (ER) with whee…](https://mymerci.kr/pages/nclex_q.php?qn_id=629677)
- [Situation: A 24-year-old woman with asthma is brought to the emergency room (ER) with whee…](https://mymerci.kr/pages/nclex_q.php?qn_id=629678)
- [Situation: A 24-year-old woman with asthma is brought to the emergency room (ER) with whee…](https://mymerci.kr/pages/nclex_q.php?qn_id=629679)
- [Situation: A 36-year-old woman comes to the Rural Health Unit (RHU), which provides free t…](https://mymerci.kr/pages/nclex_q.php?qn_id=629680)
- [Situation: A 36-year-old woman comes to the Rural Health Unit (RHU), which provides free t…](https://mymerci.kr/pages/nclex_q.php?qn_id=629681)
- [Situation: A 36-year-old woman comes to the Rural Health Unit (RHU), which provides free t…](https://mymerci.kr/pages/nclex_q.php?qn_id=629682)
- [Situation: A 22-year-old tall, thin man who smokes is admitted to the surgical ward with a…](https://mymerci.kr/pages/nclex_q.php?qn_id=629683)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._