Why is the obturator kept at the bedside? An essential guide for patient safety

September 22, 2025 •

5 min read

For tracheostomy patients, having an obturator at the bedside is a standard medical protocol, essential for patient safety. Studies show that accidental tracheostomy tube dislodgement, known as decannulation, is one of the most common complications, making the immediate availability of this tool critical for emergency airway re-establishment. Understanding Why is the obturator kept at the bedside? is key for proper care.

Quick Summary

The obturator is kept at the bedside for tracheostomy patients as a vital emergency tool for immediate reinsertion of the tracheostomy tube if it accidentally becomes dislodged. Its rounded end safely guides the outer cannula back into the tracheal stoma, minimizing trauma and preventing critical airway compromise in a crisis.

Key Points

Emergency Airway Management: The obturator is kept at the bedside to facilitate the rapid and safe reinsertion of a tracheostomy tube during accidental dislodgement, a potentially life-threatening emergency.
Trauma Minimization: Its smooth, rounded tip guides the tube gently into the tracheal stoma, reducing the risk of trauma or injury to the trachea and surrounding tissues during reinsertion.
Distinction from Inner Cannula: The obturator is only for insertion, while the inner cannula is a liner for routine cleaning; they are not interchangeable and serve different purposes.
Standard Safety Protocol: Having the obturator at the bedside is a standard clinical safety protocol to ensure it is immediately accessible when time is of the essence.
Trained Professional Use: While kept at the bedside, reinsertion of a tracheostomy tube using the obturator should ideally be performed by a trained medical professional to avoid complications, unless otherwise instructed.

The Tracheostomy: A Lifeline and Its Maintenance

A tracheostomy is a surgical procedure that creates an opening, or stoma, in the neck to place a tube into the windpipe (trachea). This procedure is performed to provide an alternative airway for individuals who have difficulty breathing due to a variety of conditions, such as chronic respiratory disease, head or neck injuries, or the need for prolonged mechanical ventilation. A tracheostomy tube consists of several components: an outer cannula that remains in place, and often an inner cannula that can be removed for cleaning. The obturator is a temporary part used only during tube insertion or reinsertion.

The Obturator's Function in Emergency Scenarios

The obturator is a curved, rigid, yet smooth rod with a rounded tip that is designed to fit snugly inside the outer cannula of the tracheostomy tube. Its primary purpose is to act as a guide during insertion. By filling the outer cannula, the obturator creates a smooth leading edge, which helps minimize trauma to the tracheal wall and surrounding tissues as the tube is guided into the stoma. Once the outer cannula is successfully placed, the obturator is immediately removed, and the inner cannula is inserted and locked into place.

Critical Danger: Accidental Decannulation

Accidental decannulation is a high-risk complication where the tracheostomy tube is unintentionally dislodged or falls out. This can occur due to excessive coughing, sudden head movements, or if the securing ties become loose. If the stoma is not yet mature, it can begin to close rapidly, making reinsertion of the tube difficult or impossible without proper guidance. A blocked airway is a life-threatening emergency that can lead to severe hypoxia and death. The risk of decannulation is precisely why the obturator is kept at the bedside and within immediate reach.

The Protocol for Bedside Readiness

The standard procedure in any clinical setting is to ensure that the patient's obturator is readily accessible, often taped to the head of the bed or kept in a bedside drawer. This is not a matter of convenience, but a critical patient safety protocol.

For Immediate Response: In the event of accidental decannulation, a healthcare provider can grab the obturator instantly without wasting precious time searching for it. Time is of the essence in this emergency.
Trauma Prevention: Using the obturator as a guide during reinsertion protects the delicate tracheal tissue from damage. Forcing a tube into a partially closed stoma can cause serious injury.
Guidance for Emergency Personnel: First responders or other staff who may be unfamiliar with the specific patient's tracheostomy can immediately identify and use the appropriate tool for reinsertion.

Obturator vs. Inner Cannula: A Clear Distinction

Understanding the different components of a tracheostomy tube is essential for safe care. The obturator and inner cannula have distinct functions and are never in the outer cannula at the same time during normal use. A comparison table can help clarify their roles.


Feature	Obturator	Inner Cannula
Purpose	Used only during insertion or reinsertion to guide the outer cannula and minimize trauma.	Fits inside the outer cannula to provide a clean airway liner that can be removed for cleaning.
Placement	Temporarily inserted into the outer cannula, then removed immediately after placement.	Remains inside the outer cannula during regular use and is locked into place.
Shape	Solid, curved rod with a smooth, rounded tip.	Hollow, curved tube that fits inside the outer cannula.
Emergency Use	Critical for emergency reinsertion if the trach tube comes out.	Used for routine maintenance; does not facilitate emergency reinsertion.

The Emergency Reinsertion Process

While the obturator is the correct tool, the reinsertion of a tracheostomy tube should ideally be performed by trained medical professionals. Patients and caregivers who have been specifically trained by a medical team may be instructed on how to perform this procedure in an emergency. The general process is as follows:

Stay Calm and Call for Help: Immediately activate emergency protocols and inform a medical professional. If alone, call for assistance while preparing.
Position the Patient: Place the patient on their back with a rolled towel under their shoulders to help extend the neck and improve visibility.
Prepare the Replacement Tube: Take the spare tracheostomy tube and insert the obturator into its outer cannula. Lubricate the tip with water-soluble lubricant or saline.
Reinsert the Tube: Gently insert the new tracheostomy tube with the obturator into the stoma, following the natural curve. Use a smooth, downward and backward motion.
Remove the Obturator: Once the tube is in place, immediately remove the obturator and listen for breath sounds.
Secure the Tube: Secure the tracheostomy ties and insert and lock the inner cannula.

A Broader Approach to Tracheostomy Safety

Keeping the obturator at the bedside is just one part of a comprehensive patient safety strategy. Ongoing care and a proactive approach are necessary to prevent complications.

Patient and Caregiver Education

Proper training for patients and their caregivers is paramount. This includes not only understanding the emergency procedure but also routine care.

Routine Cleaning: Learn how to properly clean the inner cannula to prevent mucus buildup and blockages.
Monitoring for Issues: Be aware of signs of infection, such as redness, swelling, or excessive discharge around the stoma.
Securement Check: Regularly check that the tracheostomy ties are secure and not too tight. The general guideline is to be able to fit one or two fingers snugly underneath the tie.

Equipment Management

Always ensure that there is a complete, ready-to-use tracheostomy kit available. This includes not only the obturator but also a spare tracheostomy tube of the correct size, suction catheters, and a saline solution. The obturator should be kept in a clean plastic bag to maintain sterility.

Communication with the Healthcare Team

Open and regular communication with the healthcare team, including nurses and respiratory therapists, is vital. They can provide updated training and ensure that the patient's needs are being met effectively.

For more detailed information on proper tracheostomy care and patient safety protocols, resources like Healthline can provide valuable guidance and answer common questions for patients and caregivers: How Is an Obturator Used for Tracheostomy Care?.

Conclusion: A Small Tool, A Big Responsibility

The obturator may be a small, simple medical tool, but its role in tracheostomy care is critically important. Its presence at the bedside is a non-negotiable safety measure designed for emergency preparedness in the face of accidental decannulation. By understanding its purpose, appreciating its distinction from the inner cannula, and adhering to strict bedside protocols, both healthcare providers and patients can significantly mitigate the life-threatening risks associated with a compromised airway. This simple act of preparation provides a crucial layer of security, ensuring that an emergency can be managed quickly and effectively to protect the patient's well-being.

Frequently Asked Questions

The obturator is a tool used to guide a tracheostomy tube back into the stoma, or neck opening. It has a smooth, rounded end to minimize trauma during reinsertion in an emergency.

The obturator is kept at the bedside for emergency preparedness. If the tracheostomy tube accidentally comes out (decannulation), the obturator is needed immediately to guide a replacement tube back into place to secure the patient's airway.

No, the obturator and inner cannula are different. The obturator is a solid rod for insertion only, while the inner cannula is a hollow liner that stays in the outer tube for routine cleaning and is locked into place.

In this critical emergency, immediately call for help and activate emergency medical services. Do not try to force the tube back in without the obturator, as this can cause severe tracheal trauma. Instead, focus on keeping the stoma open and preparing for the arrival of trained medical personnel.

The obturator should be kept clean, often in a small plastic bag, and taped to the wall or placed in an easily accessible drawer at the bedside. This ensures it is immediately available for emergency use, but kept sterile.

Unless specifically trained and instructed by a medical team, a family member should not attempt reinsertion. Reinsertion requires proper technique and risks serious complications if done incorrectly. The best course of action is to call emergency services.

Not having the obturator available delays the re-establishment of the airway if the tracheostomy tube dislodges. The stoma can begin to close, and an unguided reinsertion attempt risks causing significant trauma or blocking the airway, which can be fatal.