Medical Oncologist
CION Cancer Clinics
Accidental tracheostomy tube displacement: what to do | CION Cancer Clinics
If a tracheostomy tube comes out, call for help and an ambulance and sit the person up. If you are trained and the opening is well healed, put the clean spare tube in straight away, because the opening starts to close. If the operation was only days ago, do not push a tube back in. This page covers the steps, the signs of a slipped tube, and prevention. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What do you do if the tracheostomy tube comes out?
- How do you put the spare tube in at home?
- Why do tracheostomy tubes come out?
- How can you tell the tube has partly slipped out?
- What do families get wrong when the tube comes out?
- How can you stop the tube coming out?
- Common questions about a tracheostomy tube coming out
The short answer
What do you do if the tracheostomy tube comes out?
If a tracheostomy tube comes out, call for help and an ambulance at once, and sit the person up. If you have been trained and the opening is well healed, put in the spare tube straight away. If the tube came out in the first days after surgery, do not try to push it back. Call the nearest doctor or ambulance immediately.
Why speed matters
The opening in the neck is not a fixed hole. Without a tube in it, the skin and tissue start to close in, sometimes within minutes. The longer you wait, the harder it is to get a new tube in. Some people can breathe through the mouth and nose while you work. Others, after certain head and neck operations, cannot breathe at all without the tube.
Why a new opening is different
In the first days, the track from the skin to the windpipe has not yet formed a firm passage. A tube pushed in blindly can slip into the tissue beside the windpipe instead of into it. That is why a displaced tube in a fresh opening is always a job for a doctor.
This page cannot tell you whether your own tube can be replaced at home, or whether the person can breathe without it. Ask your surgeon before discharge and write the answer down.
!
Call for help before you do anything else
Shout for someone to phone 108 and say "tracheostomy tube out, breathing problem". If the person is struggling, going blue or has stopped breathing, do not wait for the ambulance to start the steps you were taught. Never force a tube into the neck. A tube that will not go in easily needs a smaller tube or a doctor, not more pressure.
Not sure whether this applies to you?
Ask an oncologistIf you have been trained
How do you put the spare tube in at home?
Position the head
Lie or sit the person with the head tipped gently back. A rolled towel under the shoulders opens up the front of the neck and makes the opening easier to see.
Take out the old tube
If the tube is half out, let the cuff down with the syringe and remove it fully. A tube hanging partway out is not doing its job and may be blocking air.
Insert the spare
Put a little water-based gel on the spare tube with its introducer inside. Slide it in with a curving movement, following the direction of the opening, back and then down.
Check it is working
Remove the introducer at once, because the person cannot breathe through it. Put in the inner tube. Feel for air at the tube and watch the chest rise.
If it will not go in
Try the smaller spare. If that fails, cover the opening with a clean gauze if your team said the mouth route works, and wait for help.
The causes
Why do tracheostomy tubes come out?
Most displacements happen during ordinary moments of the day, which is why the ties are checked so often.
Loose or wet ties
Ties stretch with wear and loosen when wet after a bath. The most common moment is while the ties are being changed, if no one is holding the tube.
Coughing hard
A strong coughing fit can push a loosely held tube outward, especially if the neck is thin or the swelling from surgery has gone down.
Pulling on the tubing
Oxygen tubing, a humidifier hose or suction tubing can drag the tube out when the person turns in bed or stands up quickly.
Confusion or restlessness
A person who is drowsy, confused or in pain may pull at the tube without meaning to, often at night.
More common with
- Strong pain medicines
- Fever or infection
- Older age after a long operation
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Not always obvious
How can you tell the tube has partly slipped out?
What you notice
What it can mean
More of the tube shows outside the neck
The tip may have come out of the windpipe.
The suction catheter will not pass
The tube may be sitting in the tissue, not the windpipe.
They can suddenly speak with the cuff up
Air is escaping around a tube that has moved.
Crackly swelling under the skin of the neck
Air is leaking into the tissue. Call for help now.
Harder breathing with no mucus found
Treat it as a displaced or blocked tube.
Commonly believed
What do families get wrong when the tube comes out?
"We will wash the old tube and put it back in."
Use the clean spare that should be in the kit. Stopping to wash a tube wastes the minutes when the opening is starting to close. The old tube can be cleaned later for the next spare.
"If he is breathing fine, it can wait until morning."
The opening can narrow over a few hours, even when breathing seems fine at first. A tube that could have gone in easily at night may not go in at all by morning. Act now, or call for help now.
"The same size tube must go back in, or it will not work."
A smaller tube is kept for exactly this reason. It goes in more easily through a narrowing opening, and it keeps the passage open until a doctor can fit the right size.
"Tight ties are safer, so we make them as tight as we can."
Very tight ties rub the skin raw and can press on the neck. One finger should slide under the ties, and no more.
Keeping it in place
How can you stop the tube coming out?
Check the ties every morning and every night, and after every bath. Always have a second person hold the tube while ties are changed. Support oxygen or humidifier tubing so its weight does not pull on the neck.
At night and when moving
Keep tubing loose enough that turning over does not tug on it. Hold the tube flange gently when the person coughs hard or sits up. If they are confused, tell the team, because medicines or the reason for confusion may need attention.
Before you leave hospital
Ask whether you are allowed to change the tube at home, and practise it on the ward with a nurse watching. Ask whether the person can breathe through the mouth if the tube is out. Keep both spare tubes, the gel, the introducers and a written emergency card together, next to the bed and in any vehicle used for travel.
Questions we are asked
Common questions about a tracheostomy tube coming out
The tube came out. Can I push it back in?
Only if you have been trained, the opening is well healed, and you have a clean spare tube. Use the spare with its introducer, not the tube that fell out. If the operation was only days ago, do not try. Call 108 or the nearest doctor at once, and keep the person sitting up.
How quickly does the hole close?
It can start narrowing within minutes, and may be hard to get a tube through within hours. How fast depends on how long the tube has been in and on the person's tissue. That is why the spare should go in straight away and why a smaller spare is kept in the kit.
What if we cannot get the new tube in?
Stop pushing. Try the smaller spare once. If it still will not go in, and your team said the person can breathe through the mouth, cover the opening with clean gauze and give oxygen to the face if you have it. Keep them upright and wait for the ambulance.
Can a person breathe without the tube at all?
Some can, if the throat above the opening is clear. Many people with head and neck cancer cannot, because of the tumour, swelling, or the operation they had. Your surgeon knows which applies. Ask them before you go home, and write the answer on the emergency card.
Should we go to hospital even if the new tube went in fine?
Call your team the same day. They may want to check that the tube is in the windpipe, especially if there was bleeding, difficulty, or crackly swelling in the neck. If breathing is worse after the change, treat it as an emergency and call the ambulance.
How tight should the tracheostomy ties be?
Tight enough that one finger slides between the ties and the neck, and no more. Check again after the person sits up, because the neck changes shape. Replace ties that are wet, stretched or dirty, with someone holding the tube the whole time.
What if the tube comes out while travelling?
Stop the vehicle somewhere safe and follow the same steps. This is why the spare tubes, gel, suction and emergency card should travel with the person. On long journeys between a district town and Hyderabad, know where the nearest hospital is along the way.
Who should learn to change the tube?
At least two people who live with or spend long hours with the person. Emergencies rarely happen when the one trained family member is home. Ask the ward to train both of you, and to watch each of you change the tube before discharge.
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Sources
- NHS — Tracheostomy
- National Cancer Institute — Tracheostomy (NCI Dictionary of Cancer Terms)
- American Cancer Society — Surgery for laryngeal and hypopharyngeal cancer
- Macmillan Cancer Support — Head and neck cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Blocked Tube: The Emergency Every Family Must KnowThe other airway emergency, and how to tell them apartChanging a Tracheostomy TubeThe routine change that trains you for this momentA Printable Tracheostomy Emergency CardTube size and breathing plan in one placeThe Parts of a Tracheostomy TubeWhat the introducer, flange and cuff are
Talk to us
Not sure your family is ready for a tube emergency?
Call the helpline. A surgical oncologist or nurse will go through the plan for your tube and tell you what to practise before discharge. One helpline serves every CION centre.