Clinical assessment

Patients with a tracheostomy should be assessed using an ABCDE approach, with tracheostomy-specific signs grouped under ‘Exposure’. These can be considered tracheostomy ‘red-flags’.1


  • Stridor or abnormal inspiratory noises – narrowing or displaced tube
  • Partial speech – in the case of a cuffed tube, this signifies air leak around the cuff which may indicate displacement or cuff leak/puncture.
  • Oral secretions


  • Apnoea
  • Tachypnoea
  • Cyanosis and hypoxia
  • Audible secretions
  • Accessory muscle use
  • If ventilated may see increased peak airway pressures, low tidal volumes, and loss of waveform capnography


  • Tachycardia
  • Hypertension or hypotension


  • Patient indicating increased pain around stoma site
  • Agitation and panic
  • Reduced responsiveness


  • Tracheostomy signs
    • Visibly displaced tracheostomy tube
    • Visible haemorrhage from or around the tracheostomy tube
    • Large volumes of air required to inflate cuff – may indicate a leak or displaced tube

If any of these signs are present, or there is a concern that a patient with a tracheostomy is deteriorating, a systematic approach is required to manage the patient’s airway.

If bleeding around or from the tracheostomy is noted, specific management may be required.

Learning bite

A “tracheostomy-focused” ABCDE assessment should identify potential problems with a tracheostomy.

Post a comment

Leave a Comment