A critical event in tracheostomy care.

Endotracheal suctioning is a potentially hazardous procedure which should be performed with care and only when indicated. The use of saline instillations before endotracheal suctioning has little or no value. Heat and moisture exchangers are effective and provide efficient humidification for artificial airways. More research is required into the timing of tracheostomy tube changes. Blockages in tracheostomy tube should be a preventable occurrence.