Clinical-use limit: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment.
Before intubation
- Identify fresh vs mature trach and laryngectomy vs tracheostomy.
- Call ENT/anesthesia/RT early and gather same-size/smaller trach, suction, BVM adapters, and oral airway equipment if upper airway exists.
- Assess obstruction, displacement, bleeding, and oxygenation route.
During intubation
- Oxygenate via the route that works: trach/stoma, mouth/nose if upper airway exists, or both if uncertain.
- Suction and remove inner cannula if appropriate.
- For mature trach displacement, replace with same/smaller device if trained and appropriate; fresh trach displacement is high risk.
After intubation
- Secure device, confirm EtCO2, reassess bleeding/obstruction, and document anatomy.
- Escalate sentinel bleeding urgently.
- Communicate laryngectomy status prominently.
Common pitfalls
- Bagging mouth/nose in a laryngectomy patient.
- Blindly replacing a fresh trach.
- Missing sentinel bleed warning signs.