Which of the following are indications that a child's tracheostomy tube should be replaced? 1. infection at the tracheostomy site 2. inspissated secretions are aspirated 3. a suction catheter cannot be passed 4. cuff pressure at minimal leak is 35 cmH2O

• A. 1 and 2 only
• B. 3 and 4 only
• C. 2, 3 and 4 only
• D. 1, 2, 3 and 4

Answer: (B)

The main idea is recognizing when a tracheostomy tube is no longer safe or effective for the child and needs to be replaced because of airway obstruction or cuff-related risk.

If infection is present at the tracheostomy site, you don’t automatically replace the tube. Infections are typically managed with local care and antibiotics while keeping the tube in place, unless there are other tube-related problems.

Being able to aspirate inspissated secretions means the airway is currently patent and suction is working, so this is not by itself an indication to replace the tube.

Not being able to pass a suction catheter is a strong sign that the tube is blocked or malpositioned, which compromises ventilation and airway patency. Replacing the tube restores a clear airway.

A cuff that requires a high pressure to achieve even a minimal leak—such as 35 cmH2O—suggests the cuff is overinflated or the tube is not fitting properly, increasing the risk of tracheal injury. In that scenario, replacing the tube with an appropriately sized one is indicated.

So, the indications are the inability to pass a suction catheter and a cuff seal requiring dangerously high pressure.