Changing a Tracheostomy Tube

The tracheostomy tube is typically changed every 1-4 weeks to prevent mucus build-up and for cleanliness. This may very depending on the particular child. Check with the doctor for frequency of trach change. Always change the trach tube with two people present (unless this is not possible in an emergency). Change the trach tube before a feeding or at least 2 hours after a feeding.

Supplies

Procedure

Tracheostomy Change

Tracheostomy Ties

Tracheostomy ties will need to be changed more often than the tube if they become soiled, wet, loose or cause pressure on the child's skin. Some specialists recommend changing ties daily, although this is usually not necessary in home care. However, infants with short fat necks, overweight children, and children on high humidification will probably need daily tie changes. Trach tie changes should also be done with two people. Twill tape comes with the tracheostomy tube or by the roll. If possible, secure new ties before removing old ties to decrease chances of the trach tube dislodging. There are several different techniques for securing the tracheostomy ties. The important things to remember are to use a knot, not a bow, and to be sure the ties are snug, but not too tight. You should be able to slip one finger under the ties. Change the position of the knot slightly with each change to avoid skin breakdown from the knot. If skin irritation does occur, place a gauze pad under the ties or use soft Velcro ties instead.

Check tension of trach ties several times a day, because ties may loosen.

Some Ways to Secure Trach Ties

Ties 

Tie 

Dale holder

Dale Medical Products, Inc.

Chain Trach Tube Holder

Metal Tracheostomy Tube Holder
More on Chain Tracheostomy Holders

Dog-tag chains (army ID tag chains) can also be adapted for a chain trach holder.  Check your local Army Surplus store.  For ties other than metal, keep a sample size tie handy for easy measuring and cutting of new ties.

You may find it easier to place your child in a sitting position to adjust and tie the trach ties.

Risk Factor Associated with Difficult Tracheostomy Tube Changes

Techniques for a Difficult Trach Change

Placement 

Illustration Source:
The Center for Pediatric Emergency Medicine (CPEM), Teaching Resource for Instructors in Prehospital Pediatrics.  Illustrations by Susan Gilbert. http://www.cpem.org/html/giflist.html

Do not force tube! If you absolutely cannot get any tube or catheter into the stoma, and the child is breathing fairly comfortably (through the stoma or through the mouth and nose), go immediately to the emergency room. Sometimes, the airway can be made worse by a trach tube inserted in the wrong place.

This page updated 05/10/2007