During a tracheostomy care procedure, the client begins coughing vigorously. What is the nurse's immediate action?

Tracheostomy tube safety during coughing:

Tube displacement risk: Coughing generates significant intrathoracic pressure — a tracheostomy tube, especially one within the first 7-10 days of placement (before the stoma tract is established), can be expelled from the stoma; if this happens, the airway may close rapidly.

Nursing action: Pause the procedure; SECURE the tube — place a hand on the tube or hold the flanges to prevent accidental decannulation; allow the cough to complete naturally; suction if secretions are in the airway after coughing.

Decannulation emergency supplies: An extra tracheostomy tube of the same size and one size smaller should be at the bedside at all times; tracheal dilators should be available.

After coughing: Assess breath sounds; assess tube placement (air movement through the tube); assess skin colour and SpO2; resume procedure only when stable.

Pn scope: Perform routine tracheostomy care per protocol; report any concerns about tube placement or client distress to RN immediately.