Watch a video on how to change a tracheostomy tube.
Tracheostomy tube changes are performed routinely in an attempt to keep the trach tube clean and prevent mucus which can plug the tube from forming.
Your doctor can help decide how often the tracheostomy tube will need to be changed. This may be once a week or as long as a month. Many brands of trach tubes can be cleaned and reused multiple times. You will receive a new trach from your equipment supplier as frequently as your insurance will allow. This will range from monthly to every 6 months.
Have another person help you with trach changes until you are confident doing it by yourself.
Gather All Equipment
It is very important to gather all equipment in one place before starting any trach tube change. Once you remove the trach, your child needs to have the new trach inserted immediately to keep their airway open and keep breathing.
Supplies You Need
- Gather all your supplies in a clean work area.
- Tracheostomy tube the same size and length of the tube currently in place
- Tracheostomy tube one size smaller than one in place (if available)
- Tracheostomy ties
- Water-based lubricant or saline drops
- Lint-free cloth
- Split gauze/dressing
- Suction supplies
- Self-inflating rescue bag
- Oxygen (optional based on individual child)
For cuffed tubes you will also need:
- Empty syringe
- Syringe with water to prescribed amount
Changing trach tube will often cause a child to cough.
Be prepared to suction or wipe secretions away. Do not let go of the tube until ties are securely fastened. Inserting a new tube can irritate the trach. You may see pink tinged secretions following a trach tube change. If you see bright red blood, report this to your doctor or nurse.
Steps to Change Tube
- Wash your hands
- Prepare suctioning equipment.You need to have this ready in case your child begins to cough up secretions.
- Place new trach ties onto one side of flange of new tracheostomy tube.
- Assure obturator is inside of new tracheostomy tube.
- For cuffed tracheostomy, check balloon on new tracheostomy tube by placing correct amount of water in balloon. Remove water.
- Place small amount of lubricant or saline drops on end of new tracheostomy tube.This is not always necessary however may be done to allow for easier, less traumatic insertion of new trach tube.
- NEVER use petroleum or Vaseline as lubricant
- Assure lubricant is water soluble.
- Place tracheotomy to be inserted on a clean surface with tip facing up. (Setting it on an unclean surface can increase chances of your child getting an infection.)
- Place child on back with small roll underneath shoulders to allow for neck extension and full view of trach.
- Check with your child’s doctor to be sure it is safe for your child to lie in this position.
- Suction child’s trach, if necessary.
- If child has cuffed trach, remember to deflate cuff.
- Unfasten trach ties on current trach, making sure to hold both sides of flange to assure tube stays in place.
- When ready, quickly remove old trach.
- Immediately insert new trach with obturator in one smooth curving motion with tip of trach directed towards back of neck. The tube should slide easily into place. Using force may cause injury, bleeding,and other problems.
- While securely holding trach in place, remove obturator immediately.
Removing the obturator allows for air to pass freely through the trach tube. Leaving an obturator in place will block a child’s ability to breathe through trach.
- Feel for air movement.
- For cuffed tracheostomy, place correct amount of water into new cuff.
- Secure trach ties around neck, allowing only one finger to fit between ties and neck. You may need to cut trach ties if they’re too long.
- Suction child’s trach.
- Make sure to check your child’s skin color and oxygen levels. Check to see if your child’s chest is rising and falling normally.
Help! I am having a problem with tube change.
If the new tube does not pass easily, do not force it!
- Keep yourself and your child calm.
- Reposition your child so the stoma is in full view and their head is extended back.
- If there are secretions at the stoma, wipe them away with gauze or clean towel.
- Double-check that you have the correct size trach tube.
- Lubricate tube.
- Try again to insert the tube.
- If your child’s condition allows, you can use a trach tube one size smaller than the one you removed. Stomas sometimes get smaller. This can happen because of scarring, swelling, or other issues. If this is the case, a smaller trach tube may pass and fit better than previous sized trach.
- Do this only if your child’s condition permits.
- If you still cannot place the tube, call 911.
- If you are unable to replace the trach tube, and the child is having trouble breathing, you may give rescue breaths with a mask over child’s nose and mouth.
- Be sure with rescue breathing to cover the stoma (hole) with gauze and tape.
- Covering the stoma makes sure that air does not escape from the stoma during breaths.
- Continue assisted breathing for child with bag and mask until help arrives.
Be sure to ask your doctor if your child's airway allows you to bag your child with a mask over their nose and mouth.