Most days with a tracheostomy pass without incident, but two situations are genuine emergencies and worth knowing cold: a blocked tube and a displaced or out tube. Recognising them early, following your hospital’s emergency plan, and knowing whether the person breathes only through the neck can be life-saving. This guide covers the red flags and the right actions — but your own hospital’s written plan and your tube type always take priority over any general advice.
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In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.
This is general information, not a substitute for the personal emergency plan your team gives you. In any tracheostomy emergency in Singapore, call 995 and start your trained steps. Keep your emergency box with you at all times.
The two big emergencies
The National Tracheostomy Safety Project (NTSP) — the recognised authority on this — notes that most serious tracheostomy incidents involve a tube that is blocked or displaced. A core NTSP principle is that a blocked or displaced tube should be acted on as soon as the problem is spotted, not left as a last resort. Everything below flows from recognising these two situations quickly and following the plan your team has written for you.
A blocked tube
A blockage — often a mucus plug — shows as severe difficulty breathing, noisy or laboured breathing, obvious distress, an inability to pass a suction catheter down the tube, a falling oxygen level, and blue lips or skin. The trained first-line response centres on suctioning and, if that does not clear it, removing or changing the inner cannula as part of your plan. If breathing does not quickly improve, this is an emergency: call 995. Do not keep trying indefinitely while someone deteriorates — get emergency help on the way early.
A displaced or out tube
A tube can fall out or be pulled out of position. This is especially dangerous in the early days before the tract has healed, when the passage can start to close and the tube can be hard to reinsert. Do not force a tube back in. Follow your emergency plan, and call 995. As with a blockage, tell responders clearly that the person breathes through a neck tube, so they manage the airway correctly on arrival.
The neck-breather distinction — the single most important point
Carers must know one thing above all: whether the person breathes only through the neck. Someone who has had a total laryngectomy is an obligate neck breather — there is no connection between the nose or mouth and the lungs, so oxygen and any rescue breaths must be given to the neck stoma, not the mouth. A face mask over the mouth and nose will not work for them. Someone with a tracheostomy may still have a usable upper airway. The NTSP publishes colour-coded emergency algorithms for exactly this — green for a tracheostomy and red for a laryngectomy. When you are unsure which applies, apply oxygen to both the face and the neck stoma.
Your emergency box
The NTSP advises keeping an emergency box with the person at all times — at home, in hospital and when out. It typically contains spare tracheostomy tubes (the same size and one a size smaller), a spare inner cannula, suction equipment, a syringe to deflate the cuff, and spare tapes or ties. The smaller spare matters because if the usual size will not go back in, a smaller one may. Check the box regularly so nothing is missing or out of date, and make sure everyone who cares for the person knows where it is and how it is used.
Bleeding, infection and other red flags
Beyond the airway itself, seek urgent help for heavy bleeding from the tube or stoma — light spotting after suctioning can occur, but more than that, or bright ongoing bleeding, needs emergency care (call 995). Watch too for signs of a serious chest or stoma infection: high fever, spreading redness, foul or increasing secretions, and worsening breathlessness all warrant prompt medical review. And if an attempted tube change simply will not go in, treat it as an emergency and, for a neck breather, deliver oxygen to the stoma while waiting for help.
What to do — the plan in Singapore
Put simply: for any severe breathing difficulty, a tube that is blocked and will not clear with your trained steps, or a tube that has come out and cannot be safely replaced, call 995 immediately and start the emergency steps your team taught you. Tell responders the person breathes through a neck tube, and whether they are a neck breather. Keep your emergency box within reach, keep your tube type and size written down, and make sure family are trained. Knowing these few red flags — and acting on them fast — is the heart of living safely with a tracheostomy.
Related tracheostomy topics
- Living with a tracheostomy
- Tracheostomy: what to expect
- Caring for your tracheostomy
- Suctioning & secretions
- Tube changes & the inner cannula
- Speaking & communication
- Eating & swallowing
- Living with a laryngectomy
- Emotional wellbeing & daily life
- ENT specialists in Singapore
- ENT clinics in Singapore
Sources
- NTSP — Emergency care (adults): tracheostomy.org.uk
- National Tracheostomy Safety Project: tracheostomy.org.uk
- NALC — Resuscitation: laryngectomy.org.uk
- Cancer Research UK — Having a breathing stoma: cancerresearchuk.org