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Decannulation: getting the tracheostomy tube out | CION Cancer Clinics
Decannulation means taking a tracheostomy tube out for good. It is done in stages once you can breathe, cough and swallow safely without it: the cuff is let down, a smaller tube or speaking valve may follow, and the tube is capped for longer spells. If that goes well, it is removed and the opening closes under a dressing. This page explains each stage and who it does not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
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 is decannulation, and how is the tube taken out?
- How does the team know you are ready?
- What are the steps to getting the tube out?
- What do families often believe about getting the tube out?
- How do you know a capping trial is going well?
- How do you look after the opening once the tube is out?
- Common questions about decannulation
The short answer
What is decannulation, and how is the tube taken out?
Decannulation means removing the tracheostomy tube for good. It is done step by step, once the reason for the tube has passed and you can breathe, cough and swallow safely without it. The team tests this gradually, then removes the tube and covers the opening with a dressing while it closes on its own.
Why it is done slowly
The tube has been doing part of the work of breathing. Taking it out suddenly would test the throat all at once. Instead, the team lets the cuff down, may change to a smaller tube, and blocks the tube for longer and longer spells. If you manage each stage, you move to the next.
Who it does not suit
Not every tracheostomy is meant to come out. If the throat above the tube is still narrowed by swelling, scarring or the cancer, the tube may need to stay. Some people keep it through radiotherapy, because the neck can swell during treatment. A few people have a permanent opening.
This page cannot tell you when your own tube will come out. That depends on your operation, your airway and any treatment still planned. Your surgeon will explain what they are waiting for.Before the first step
How does the team know you are ready?
They look at the whole picture, not one test. You usually need most of these in place.
An open airway above the tube
Air has to pass freely through the voice box and mouth. The surgeon may look with a thin camera through the nose to check for swelling or narrowing.
A cough that clears mucus
Without the tube, you must cough mucus up and out through the mouth. If you still need frequent suction, it is usually too soon.
A safe swallow
Saliva and food must go down the food pipe, not into the windpipe. A swallowing check is often part of the decision.
Nothing big still ahead
The team considers what treatment is still planned. Removing a tube only to need it again a few weeks later helps no one.
The tube may stay for
- Another operation on the head or neck
- Radiotherapy to the throat
- A chest infection that has not settled
Not sure whether this applies to you?
Ask an oncologistStage by stage
What are the steps to getting the tube out?
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Cuff let down
If your tube has a cuff, it is let down so air can pass around the tube and up through the voice box. The team watches your breathing and whether saliva is going the wrong way.
-
A smaller or uncuffed tube
Many people change to a slimmer tube. It leaves more room for air to pass around it, which makes the next steps easier.
-
Speaking valve
A one-way valve lets you breathe in through the tube and out through the mouth. You get used to moving air through the throat again, and you can talk.
-
Capping trials
The tube is closed with a cap, so all breathing goes through the nose and mouth. It starts with short spells while awake and builds up to a full day and night, including sleep.
-
The tube comes out
If capping goes well, the tube is removed on the ward. It takes moments and is not usually sore. An airtight dressing goes over the opening.
-
Watched afterwards
You are usually observed before going home, to be sure breathing stays comfortable without the tube.
Commonly believed
What do families often believe about getting the tube out?
"A failed capping trial means the tube will never come out."
It usually means not yet. Many people need more than one attempt as swelling settles and strength returns. The team may wait, try a smaller tube, or check the airway with a camera before trying again.
"The hole will need stitches or another operation to close."
Most openings close on their own under a dressing. Only a small number stay open and need a minor procedure to close them. Your team will tell you if yours is slow.
"We can speed things up by keeping the cap on at home."
Only cap the tube if your team has told you to and shown you how. A capped tube with the cuff up stops all breathing. Pushing ahead faster than planned can end in an emergency.
"Once the tube is out, the risk is over."
Breathing is watched for a reason. A few people struggle after removal, often at night. Know the warning signs, and keep your team's number close in the first days at home.
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During capping
How do you know a capping trial is going well?
Going well
Signs to take the cap off
Breathing is quiet and steady
Noisy, high-pitched or laboured breathing
Mucus is coughed up through the mouth
Mucus that cannot be cleared
Speaking and eating as usual
Breathless on talking or at rest
Sleeping through with the cap on
Waking frightened, sweaty or confused
Colour looks normal
Grey or blue lips or fingertips
After the tube is out
How do you look after the opening once the tube is out?
Keep the dressing on and change it when it gets wet or dirty. Press gently on the dressing with your fingers when you cough, speak or swallow. This stops air escaping and helps the opening close faster.
What is normal in the first days
A little air or mucus may leak through the dressing. Your voice may sound weak at first. The opening usually shrinks over days and closes over a few weeks, leaving a small scar that fades with time.
What to avoid
Keep water off the dressing while the opening is still open, and do not swim. Avoid dusty places and smoke. Do not apply powders, pastes or oils to the wound. Ask your team before lifting anything heavy or straining.
When to call the team
Call the same day if the dressing keeps soaking through, if the skin around the opening turns red and hot, or if you notice a bad smell or yellow discharge. Call too if your voice was getting stronger and then becomes weaker, or if swallowing becomes harder. These are not always serious, but they are worth a check.
!
Breathing trouble after the tube is removed
If breathing becomes noisy, hard work, or the person cannot clear mucus, sit them up and call 108 straight away. Tell the crew that a tracheostomy tube was removed recently. Fever, pus or spreading redness at the opening needs a call to your team the same day.
Questions we are asked
Common questions about decannulation
How long does decannulation take?
It varies a great deal. Some people go from cuff down to tube out within days. Others need weeks, especially after larger operations or radiotherapy. Each stage only moves forward when the last one went well. Your team can give you a rough idea once they have seen how you manage the first steps.
Does it hurt when the tube is taken out?
Most people feel a short tug and some coughing, and it is over in moments. The opening may feel sore for a few days afterwards, which ordinary pain relief your team prescribes usually eases. Tell the nurse if it hurts more than expected.
Will I be able to speak normally after?
Many people speak more easily once the tube is out, especially when pressing on the dressing. The voice can stay weak or hoarse for a while. If your operation involved the voice box or tongue, speech may be different, and a speech therapist can help.
Can decannulation be done at home?
The final removal is usually done in hospital, where breathing can be watched. Some teams let people continue capping trials at home once they have been shown how. Only do this with clear written instructions, and never cap a tube with the cuff up.
What happens if the opening does not close?
Most openings close on their own. If one stays open for longer than your team expects, they may check for a reason, such as infection or tissue that has healed in an unusual way. A small procedure can close it if needed. Tell your team if air still leaks after several weeks.
Can the tube have to go back in?
Sometimes. If breathing becomes difficult after removal, or new treatment causes swelling in the throat, a tube may be needed again. This is not a failure, and it is one reason people are watched after removal. The team will explain what they saw and what happens next.
When can I bathe normally again?
Keep water off the dressing until the opening has closed and your team agrees. Until then, a careful bucket bath below the neck is the safer choice. Swimming should wait until the wound has fully healed and your surgeon says it is safe.
What should we ask before going home?
Ask how to change the dressing, what signs mean you should call, and who to call at night. Ask when the next clinic visit is, and whether any spare equipment should stay at home for now. Ask what the team expects the scar to look like once the opening has closed.
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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.
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