Downsizing or Decannulation of Tracheostomy Tubes

 

VBMC TRAUMA CARE SERVICES GUIDELINE

TITLE: Downsizing or Decannulation of Tracheostomy Tubes
PURPOSE: To clearly delineate the criteria and circumstances under which the safe downsizing or removal of a patient tracheostomy tube may be performed.

GUIDELINE: Members of the trauma service may independently downsize, change or remove a tracheostomy tube after successful demonstration of the necessary cognitive and psychomotor skills under the supervision of an attending physician.

The tracheostomy must have been in place for a minimum of seven days.

Downsizing may be considered in patients with controlled secretions and minimal ventilatory requirements. Decannulation may occur if a patient is following commands, moving air around the trach, able to cough and handle secretion, and no longer requiring oxygenation supplementation. Prior to decannulation, the patient must tolerate capping of the tracheostomy tube with an occlusive cap for at least 24 consecutive hours. All patients undergoing a downsize or decannulation, whether in the inpatient or outpatient setting, will be monitored post-procedure for a minimum of thirty minutes for signs of respiratory distress or complications.

PROCEDURE: At the discretion of the Trauma and Surgical Critical Care team, a trauma and surgical critical care resident or the Trauma PA may downsize, change, or remove a tracheostomy tube. The procedure will be performed in accordance with the patient services policy and procedure referenced above. The provider may increase their knowledge and understanding of tracheostomy tubes by reviewing the guideline for tracheostomies tubes.

PERFORMANCE IMPROVEMENT: The provider must demonstrate competency by the successful demonstration of three downsizes or removals under the supervision of an attending physician or a peer who has demonstrated ongoing competency under the supervision of an attending physician. After three successful downsizes or decannulations, the provider may perform the procedure independently and supervise other providers. In accordance with ongoing annual competency, the provider must demonstrate one successful downsize or decannulation per year to maintain proficiency.

 

RESOURCES/REFERENCES:

Groves, D. S. & Durbin, C. G. (2007). Tracheostomy in the critically ill: Indications, timing, and techniques. Current opinion in critical care, 13(1) 90-97.