Mechanical

Accidental extubation / tube dislodgement

Before / During / After / Pitfalls

Before

• Recognize risk: movement, transport, agitation, loose securement, facial trauma, burns, pediatrics.
• Have BVM, suction, rescue airway, and reintubation pathway ready before transport/procedures.
• Use waveform EtCO₂ and tube depth as continuous situational awareness.

During

• If patient deteriorates, remove from ventilator, bag with 100% O₂, and verify tube position immediately.
• Absent/changed waveform or depth change should trigger displacement concern.
• Reintubate/rescue oxygenate if tube is out or not functioning.

After

• Re-secure, document depth, reassess CXR/ultrasound as appropriate, and debrief why it occurred.
• Adjust sedation/restraints/transport plan to prevent recurrence.
• Update handoff with high dislodgement risk.

Pitfalls

• Attributing hypoxia to lungs while the tube has moved.
• No tube-depth checks after transport.
• Loose securement in facial burns/trauma/pediatrics.