In the case of a suspected trachea-innominate artery fistula, after removing the tracheostomy tube, the next immediate action is to:

In the case of a suspected trachea-innominate artery fistula, applying direct pressure to the innominate artery at the stoma site is critical for controlling potential bleeding and stabilizing the situation. When a fistula occurs, there is a high risk of significant hemorrhage due to the proximity of the innominate artery to the trachea. Immediate direct pressure can help to occlude the artery, reduce blood loss, and prevent exsanguination, which is essential in a potentially life-threatening scenario.

This action takes priority because it addresses the most immediate threat - controlling the bleeding - rather than focusing on airway management or other supportive measures. Other options such as inserting a new tracheostomy tube or starting an IV line would not provide the urgent intervention needed to manage bleeding in this situation, and notifying a respiratory therapist, while important for continued patient care, is not a critical immediate measure when faced with an emergency involving arterial bleeding.