Tracheotomy Care

Tracheotomy Tie Change

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Purpose | When | Supplies | How to Change Twill Ties l How to Change Self-Fastening (Velcro") Ties

Purpose

Tie changes are done to prevent the tracheotomy tube from falling out, and to prevent skin breakdown and rashes on the neck.

When

Ties are changed at least daily or when ties are wet or dirty.

Supplies

You will need the following supplies for suctioning your child's tracheotomy tube:

Scissors
Hemostats
Extra tracheotomy ties
Optional Self-fastening ties

How to Change Twill Ties

Here are the steps you need to know for changing the twill tie for your child's tracheotomy tube:

Ask a second person to help with tie change. The second person will hold the tracheotomy tube in place while the first person is changing the ties.
If possible during the tie change, do not cut the old ties until the new ties are secured. Slide the soiled ties up or down to allow you to put the new ties on the flange at the same time.
Cut two pieces of cotton twill tape long enough to fit around the neck and be tied.
Cut at an angle to prevent fraying. Fold the angled end over about ½ inch and poke a small hole into the doubled end about ¼ inch from the fold.
Thread the tape through the hole of the tracheotomy tube flange from back to front. Pull the other end of the tie through the hole using the hemostats' or tweezers. Pull tightly while holding the tube. (This secures the tie to the tube without using knots and does not tug the tracheotomy tube from the child's neck.)
Repeat the process for the other side of the tube. Bring both pieces of tie together and tie a square knot.
Check the new ties and see that only one finger can slide under the ties. The location of the knot should be moved each time it is tied to prevent skin breakdown. Flex the child's head slightly while tying to ensure the ties are secure in all positions. If irritation is noted on the neck, protection can be applied. This involves either placing a gauze pad at the point of rubbing or using different ties.
Cut the old ties and remove them. Re-check the new ties to be sure that only one finger can slide between the ties and the neck. The second person must hold the tracheotomy in place as the first person secures the new ties. Secure the ties by tying three square knots.

How to Change Self-Fastening (Velcro") Ties

Some children are switched to self fastening ties following their tracheotomy tube change on the 5th POD, because they are easier to use and less irritating to most necks. However, they are not for every child. Style and fit is very important for safe use. Some children's skin is sensitive to the material in the neck tape. They are expensive, and some insurances limit the number used. If your doctor permits you child to use them, a prescription will be sent to your equipment company. There are several brands from which to chose that may help fit your child's needs.

How To Change Self-Fastening Ties

Here are the steps you need to know for changing the twill tie for your child's tracheotomy tube:

Remove the old ties, while the second person holds the flange of the tracheotomy tube.
Slip the self-fastening tab through the opening of the tracheotomy flange, folding it back onto the cloth material to fasten it securely.
Repeat this step on the other side.
With the child's head flexed forward slightly, bring the two ends together, fastening the third self-fastening tab to the material.
Check that self-fastening ties are secure, only allowing one finger to fit between the tie and the neck.

Tips

If using self-fastening ties you must check the self-fastening ties often throughout the day to make sure the Velcro" is secure.
If cleaning and reusing Velcro" ties, the ties must be checked to see that the Velcro" hold is still strong. They can only be washed in mild soap and water, and line dried.

Revised 7/07