What should the respiratory therapist do if a patient's tracheostomy tube is expelled after an explosive cough during hygiene care?

When a tracheostomy tube is expelled, especially following an explosive cough, it is critical to prioritize the airway management and ensure proper ventilation for the patient. Replacing the tracheostomy tube with a new one is advised because the expelled tube can have residual secretions, be contaminated, or may not fit properly if reinserted, posing a risk for airway obstruction.

Using a new tube reduces the likelihood of introducing infection and ensures that the stoma (the opening in the neck) is properly managed. The new tube is more likely to create a secure airway, essential for the patient's breathing.

In situations where a tracheostomy tube becomes dislodged, rapid action is necessary to prevent hypoxia, and simply attempting to reinsert the expelled tube may not provide a safe or effective airway. For similar reasons, rinsing the expelled tube and reinserting it may not be safe due to the factors mentioned, and performing oral intubation, while an alternative airway management strategy, is more invasive and not the first-line response for a tracheostomy patient. Retrieving the tube and reinserting it into the stoma also carries risks, especially if the tube cannot be adequately cleared or fails to fit securely.

In summary,