Assess the airway with patient supine on a flat surface. You can still utilize the “head-tilt-chin-lift” method to inspect the tube and / or stoma for blockage, crusts, dislodgement or kinks. Ensure that when tilting the chin upward do not press on soft tissue as well.
Suctioning may clear an obstruction, but if you feel resistance, begin alternate troubleshooting ideas immediately. Never interrupt chest compressions to troubleshoot the airway. Consider staffing configurations and ensure you have adequate personnel to perform all necessary tasks. If you are unable to establish a patent tracheostomy tube via the original tracheostomy tube consider removal of the current tracheostomy tube and begin BLS ventilations via bag-valve-mask.
As previously discussed with tracheal tube replacement use the same size tube or one that is a size smaller if the same size tube is not available. If necessary, remove the obturator and thread a suction catheter through the tube. If the stoma has closed, remove the obturator from the small tube, passing a suction catheter through the tube. Try to insert the end of the catheter through the stomal opening to allow you to guide the tracheostomy tube along the catheter and through the stoma, or Seldinger technique.
