Tracheotomy Care

Tracheotomy Tube Change

Related Services

Download the Tracheotomy Care Handbook
PDF You can download the entire Tracheotomy Care Manual (1166k) in portable document format (.pdf).

Download the free Adobe Acrobat Reader. You must have Adobe Acrobat" Reader installed on your computer to read this file. You can download Adobe Acrobat" Reader at Adobe's Web site by selecting the version appropriate for your type of computer.

Purpose | When | Supplies l How to Change l Tip

Purpose

To prevent mucus plugs in the tracheotomy tube and to keep the tracheotomy tube clean.

Back to Top

When

Change the tracheotomy tube every 1-2 weeks. It is helpful to have 2 people present to change the tracheotomy tube. In an emergency, you must be prepared to change the tube by yourself.

Back to Top

Supplies

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

  • Two trained people are preferred for routine changes
  • Current size tracheotomy tube
  • Size smaller tracheotomy tube
  • Tracheotomy ties
  • Water-based lubricant
  • Scissors
  • Hemostats (or blunt tipped tweezers)
  • Supplies for suctioning
  • Tissues
  • Breathing Bag

Back to Top

Proper placement for child's head during trach tube change.
Check with your doctor or nurse before placing your child in this position. Some children should not be placed in this position.
 
 
Illustration of how to insert new trach tube.

How to Change

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

  • Wash and dry hands
  • Prepare ties and tie to flanges, place tracheotomy tube on clean surface. Avoid touching the cannula on any
    unclean surface.
  • Prepare suctioning equipment
  • Suction your child's tracheotomy tube
  • Place the child on his / her back with a small roll under his / her shoulders
  • One person cuts or loosens the ties, holding the tracheotomy tube in place and calms the child.
  • The second person moistens the tip of the tracheotomy tube with lubricant.
  • The first person removes the old tracheotomy tube when the 2nd person is ready.
  • The 2nd person inserts the tracheotomy tube in one smooth curving motion, directing the tip of the tracheotomy tube toward the back of the neck. DO NOT FORCE THE TUBE!!
  • Remove the obturator, holding the tracheotomy tube securely. Feel for air movement with your fingers, or check for coughed or suctioned secretions.
  • Changing the tracheotomy tube will cause the child to cough. Have tissues ready to wipe secretions or prepare to suction and DO NOT LET GO OF THE TUBE!!!
  • Tie the tracheotomy ties only allowing room for one finger between the neck and the ties.

If the Tube Does Not Pass Easily

Here are the steps to take if the tube does not pass easily:

  • DO NOT FORCE THE TRACH TUBE!
  • Hold the tube in place, remove the obturator, and let the child relax and breathe
  • Try to insert the tube again.
  • Reposition the child so the head is back and the stoma can be seen.
  • Remove the tube, relubricate, and try again.
  • Try to insert the size smaller trach tube.
  • Insert a suction catheter through the size smaller trach tube. Guide the suction catheter into the stoma. Then slide the trach tube over the suction catheter and into the stoma. Remove the suction catheter.
  • Ask someone to call for emergency help if not able to replace the trach tube
  • Call you doctor for advice if only the size smaller trach tube can be placed.

Back to Top

Tip

It is helpful to have emergency tubes set up with ties and in a small plastic bag, ready to go should an emergency occur.

Back to Top

Revised 7/07