What is the primary risk when caring for a patient with a new tracheostomy?

• A. Dislodgement
• B. Infection
• C. Bleeding
• D. Pneumonia

Answer: (A)

Protecting the airway is the most urgent concern after a new tracheostomy. The primary risk is accidental dislodgement of the tracheostomy tube, because the fresh tract is small and not yet stabilized, so coughing, movement, or suctioning can push the tube out. If the tube becomes displaced, airway patency can be lost quickly, leading to hypoxia. Nursing focus is on prevention and rapid response: keep the tube secured with ties, have a spare tracheostomy tube and an obturator at the bedside, and be prepared to reinstate the airway immediately if dislodgement occurs. If reinsertion isn’t possible right away, seek help and provide oxygen while airway management is reestablished. While infection, bleeding, and pneumonia are important concerns in tracheostomy care, they are less likely to be the immediate threat in the early post-placement period compared to airway loss from dislodgement.