Medical Oncologist
CION Cancer Clinics
Blocked tracheostomy tube: the emergency every family must know | CION Cancer Clinics
A blocked tracheostomy tube means the person cannot get air in or out, and it needs action within moments. Call for help and an ambulance, sit them up, remove any valve and the inner tube, and try to pass a suction catheter. This page sets out the signs, the emergency steps in order, what belongs in the bedside kit, and how most blocks can be prevented. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- How do you know a tracheostomy tube is blocked?
- What do you do when the tube is blocked?
- Why does a tracheostomy tube get blocked?
- What mistakes do families make in a blocked-tube emergency?
- What should be in the emergency kit?
- How can you stop the tube blocking again?
- Common questions about a blocked tracheostomy tube
The short answer
How do you know a tracheostomy tube is blocked?
A blocked tracheostomy tube is an emergency because the person cannot get air in or out. Call for help at once, remove the inner tube, and try to pass a suction catheter. If breathing does not improve within moments, follow the emergency steps your team taught you and call the emergency number.
The signs to watch for
The person struggles to breathe, pulls in hard at the neck or ribs, and cannot move air through the tube. You may hear a whistling sound, or no sound at all. They may look frightened, sweaty or confused. The lips or fingertips can turn grey or blue. A suction catheter will not go down the tube, or stops partway.
Why every family member must know this
A block can happen at night, at a meal or in a vehicle, when the person who was trained on the ward is not in the room. In those moments there is no time to find a phone number or read instructions. Everyone who may be alone with the person should know the steps by heart.
This page explains the usual order of steps. Your team may have given you a plan for your own tube. Where the two differ, follow your team's plan.
!
Do this first, before anything else
Shout for someone to help and to call 108 for an ambulance. Say the words "tracheostomy" and "cannot breathe". Do not leave the person to make the call yourself if anyone else is in the house. Do not wait to see whether it settles. Start the steps below while help is on its way.
Not sure whether this applies to you?
Ask an oncologistIn order
What do you do when the tube is blocked?
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Sit them up and look
Sit the person upright. Look, listen and feel for breath at the mouth and at the tube. Give oxygen to both the face and the tube if you have it at home.
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Take off anything on the end
Remove the speaking valve, cap or moist filter. Sometimes that alone is what was blocking the air.
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Take out the inner tube
Most blocks sit in the inner tube. Pull it out. If breathing eases, put in a clean spare inner tube.
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Try to pass a suction catheter
If it goes down easily, suction the tube. If it will not pass, the tube is blocked lower down or has moved out of place.
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Let the cuff down, if trained
If the tube has a cuff and you were shown how, empty it with the syringe. This lets some air pass around the tube.
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Change the tube, if trained
If the person still cannot breathe, take the tube out and put in the spare, or the smaller spare if it will not go in. Never force a tube.
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If they stop breathing
Start chest compressions as the ambulance call handler guides you. Your team will have told you whether rescue breaths go to the mouth, the neck opening, or both.
The causes
Why does a tracheostomy tube get blocked?
Most blocks build up slowly over hours or days before they become an emergency. Knowing the causes is how you prevent them.
Thick, dried mucus
Air breathed through the neck skips the nose, which normally moistens it. Mucus dries and forms a sticky plug or a hard crust inside the tube.
An inner tube not cleaned
Mucus builds up layer by layer on the inside wall. A tube that is not cleaned as often as advised narrows until air cannot pass.
Blood clots
Blood from the wound, from rough suction or from the windpipe lining can clot inside the tube, especially in the first days after surgery.
A tube that has moved
A tube can slip partly out or turn so its tip presses against the windpipe wall. It looks like a block, and the suction catheter will not pass.
More likely when
- The ties are loose
- The neck swelling has gone down
- The person is restless or confused
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Commonly believed
What mistakes do families make in a blocked-tube emergency?
"We should drive him to the hospital ourselves, it is faster."
A person who cannot breathe may not survive the journey without help on the way. Start the steps at home and call the ambulance. If you must travel, someone other than the driver keeps working on the tube.
"If the catheter will not go in, push harder."
Pushing can damage the windpipe and will not clear a solid block. A catheter that will not pass is the signal to move to the next step, not to force it.
"Only the nurse should ever touch the tube."
In an emergency at home, there is no nurse in the room. Families who practise the steps on the ward act faster and more calmly. Ask to be trained before discharge, and to change the tube with a nurse watching.
"Putting a few drops of water in will loosen it."
Do not pour water or anything else into a blocked tube. Use only what your team showed you, such as saline, and only in the way they showed you.
By the bed, always
What should be in the emergency kit?
- A spare tube of the same size, with its introducer
- A spare tube one size smaller
- A clean spare inner tube
- A charged suction machine and fresh catheters
- Clean ties, scissors and a syringe for the cuff
- Water-based gel and saline, if your team advised them
- A torch for power cuts at night
- A card with the tube type, size and your team's number
Preventing the next one
How can you stop the tube blocking again?
Most blocks can be prevented with daily care. Keep the air moist, clean the inner tube as often as you were told, and suction when the tube sounds wet. Thick or crusty mucus is an early warning, not a normal part of life with a tube.
Practise before you need it
Go through the steps out loud with every family member who helps with care. Check the kit each night. After any emergency, tell your team what happened, even if it cleared, because they may change the tube type or the care plan.
What this page cannot tell you
It cannot tell you whether your tube can be changed safely at home, or whether the person can breathe through the mouth if the tube comes out. That depends on the operation and on the throat above the tube. Ask your surgeon directly, and write the answer on the emergency card.
Questions we are asked
Common questions about a blocked tracheostomy tube
What is the first thing to do if the tube is blocked?
Call for help and get someone to phone 108. Then sit the person up, remove any valve or cap, and take out the inner tube. That alone clears many blocks. If breathing does not improve, try to pass a suction catheter and move through the steps you were taught.
How do I tell a blocked tube from a tube that has come out?
From the outside they can look the same. The tube may seem longer, the ties loose, or the person may be able to speak when they could not before. In both cases the suction catheter often will not pass. The emergency steps are largely the same, so do not lose time deciding.
Can he breathe through his mouth if the tube is blocked?
Sometimes. If the throat above the tube is open, covering the neck opening may let air pass through the mouth and nose. After some head and neck operations, it is not possible. Your surgeon can tell you which applies, and it should be written on the emergency card.
Should we change the whole tube ourselves?
Only if you have been trained to and your team says it is safe for this tube. A new opening can close or form a false passage if a tube is pushed in wrongly. If you have not been trained, focus on the inner tube, suction and calling the ambulance.
What if the power goes off and the suction machine stops?
Ask your supplier for a battery-powered or manual suction unit as a backup, and keep it charged. In a power cut, removing and cleaning the inner tube still works. Keep a torch with the kit so you can see the tube clearly at night.
Do we need to tell the ambulance anything special?
Say clearly that the person has a tracheostomy and cannot breathe. Give the address with a landmark. When the crew arrives, show them the emergency card and the spare tubes. Tell them whether the person can breathe through the mouth, if your team has told you.
How can we tell a block is starting before it becomes an emergency?
Watch for suction being needed more often than usual, thick or crusty mucus, a whistle on breathing, or the person seeming more tired and breathless. Crusts on the inner tube are a clear sign. Increase humidification and clean the inner tube, and call your team if it does not settle.
Should we go to the hospital after the block has cleared?
Call your team the same day, even if the person now seems well. A block can come back, and the lining may be sore or bleeding. If the person was without air for any time, was confused, or needed the tube changed, they should be checked in person.
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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
A Printable Tracheostomy Emergency CardThe card to keep by the bed and in the carAccidental Tube DisplacementWhen the tube has come out rather than blockedCleaning the Inner TubeThe daily job that prevents most blocksHumidification and Preventing CrustingWhy dry air makes mucus plug the tubeComplications and Red FlagsOther warning signs after cancer surgery
Talk to us
Want your family trained before going home?
Call the helpline. A surgical oncologist or nurse will talk you through the emergency plan for your tube and tell you what to practise on the ward. One helpline serves every CION centre.