The Importance of Tracheostomy Progression in the Intensive Care Unit

Author(s): Linda L. Morris, PhD, APN, CCNS, FCCM

Contact Hours 1.00

CERP A 1.00

Expires Feb 01, 2018

Topics: Pulmonary

Member: Free
NonMember: $10.00

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Activity Summary

A plan to progress a tracheostomy toward decannulation should be initiated unless the tracheostomy has been placed for irreversible conditions. In most cases, tracheostomy progression can begin once a patient is free from ventilator dependence. Progression often begins with cuff deflation, which frequently results in the patient’s ability to phonate. A systematic approach to tracheostomy progression involves assessing (1) hemodynamic stability, (2) whether the patient has been free from ventilator support for at least 24 hours, (3) swallowing, cough strength, and aspiration risk, (4) management of secretions, and (5) toleration of cuff deflation, followed by (6) changing to a cuffless tube, (7) capping trials, (8) functional decannulation trials, (9) measuring cough strength, and (10) decannulation. Critical care nurses can facilitate the process and avoid unnecessary delays and complications.


  • Discuss a systematic method for tracheostomy progression
  • Describe how critical care nurses can facilitate the process of decannulation
  • List outcomes achieved with a standardized clinical practice guideline for tracheostomy patients

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Successful Completion

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