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Airway Red Flags

Tracheostomy Red flags


Tracheostomy red ‘flags’ can be divided up into three different categories:


  1. Airway flags

  2. Breathing flags

  3. Specific tracheostomy flags



Airway flags


Like any assessment of an unwell patient, always start with Airway. In a patient with a TRACHEOSTOMY, there may be TWO AIRWAYS to consider. In a LARYNGECTOMY patient, there is only ONE AIRWAY to consider.


Grunting, snoring or stridor are signs of an airway problem.


If a patient has an inflated cuffed tracheostomy that is correctly positioned, NO GAS SHOULD ESCAPE through the mouth.

If the patient is talking or has an audible air leak or bubbles of saliva are seen or heard at the mouth or nose, then GAS IS ESCAPING PAST THE CUFF. This may imply that the cuff is deflated or damaged or the tube is not correctly sited.



Breathing flags


Assess breathing by observation and auscultation. The patient may not be breathing or may have difficulty breathing.  This may be reported by the patient or observed clinically:

  • Accessory muscle use

  • Increased respiratory rate

  • Higher airway pressures

  • Lower tidal volumes

  • Has hypoxia

  • Is making whistling noises or has noisy breathing


Specific tracheostomy flags

Careful observation may show

A) That the patient:

  • Has a visibly displaced tracheostomy tube. If the patient has an adjustable flange tube, check to see where it was last positioned

  • Has blood or blood-stained secretions around the tube - a recently performed or changed tracheostomy bleeds a little, but if in doubt, you should get it assessed

  • Reports increased discomfort or pain


B) The tracheostomy cuff requires increasing amounts of air to keep it inflated because either:

  • The cuff is damaged or has an air leak or

  • The tube may be displaced and the cuff needs hyper-inflation to keep it 'sealed'

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