What is the most likely cause of sudden agitation and drop in SpO2 after a tracheostomy tube change?

• A. Inadvertent closure of the tracheostomy opening
• B. A need to suction the patient
• C. A tracheostomy tube that is too small
• D. Malpositioning of the tracheostomy tube

Answer: (D)

A sudden agitation and drop in SpO2 after a tracheostomy tube change can be most confidently attributed to malpositioning of the tracheostomy tube. When a tracheostomy tube is not positioned correctly within the airway, it can lead to inadequate ventilation or obstruction, ultimately resulting in decreased oxygen saturation levels. This malposition can occur if the tube is placed too high, too low, or in an incorrect orientation, which impedes airflow and interferes with the patient’s ability to breathe effectively.

In such scenarios, patient agitation often manifests due to the distress caused by hypoxia or difficulty in breathing. Ensuring the tracheostomy tube is properly positioned within the trachea is vital for maintaining airway patency, facilitating effective ventilation, and preventing complications such as accidental decannulation or obstruction.

While some other options may seem plausible, they do not account for the immediate and severe symptoms observed after the tube change as clearly as malpositioning does. For instance, inadvertent closure of the tracheostomy opening generally results in more gradual symptoms, and the need to suction might show similarly but would not immediately account for the drop in SpO2 upon changing the tube. A tube that is too small could lead to