What to do if the trach comes out

1. STAY CALM!
2. Hyperextend neck slightly.
3. Remove inner cannula from trach—replace with obturator.
4. Completely deflate trach cuff.
5. Use small amount of saline to lubricate neck and trach tube.
6. Carefully insert trach into neck opening. Use the same arching motion used when inserting the inner cannula during routine trach care.
7. Once in place, IMMEDIATELY remove the obturator.
8. Check for air movement through trach tube—listen carefully!
   If no air movement through tube is noted, remove the tube, replace the obturator, reposition, and calmly try again to insert the tube.
9. After assuring proper placement, replace inner cannula, auscultate, then inflate cuff.
10. Check for proper breath sounds, again, prior to connecting ventilator circuit to trach tube.