Tracheostomy: How to change your child's tracheostomy tube

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Once your child has a tracheostomy tube inserted, you will need to change it regularly.

Routine tracheostomy tube changes are important to prevent mucus from building up and prevent granulation tissue from forming around the tube. Granulation tissue is the natural build-up of skin cells o​n the surface of a cut or incision, or may be a reaction to the plastic in the tracheostomy tube.

You will also need to change your child’s tracheostomy tube in case of emergency​, for instance if your child has trouble breathing or the tube accidentally falls out.

How often should I change my child’s tracheostomy tube?

Do a routine tracheostomy tube change once a week. In some cases, you will change the tube once every two weeks. Your child’s healthcare team will tell you exactly how often your child will need to have their tube changed. The healthcare team will also advise you how often you should throw out used tracheostomy tubes and replace them with new ones.

How long does it take to change a tracheostomy tube?

Once you are familiar with the process, a routine tracheostomy change will take about 20 to 30 minutes from start to finish.

Can I change my child’s tracheostomy tube on my own?

Routine tracheostomy tube changes should be performed by two people: a main person and an assistant. In case of emergency, one person may perform a tracheostomy tube change.

Below, you will learn:

Before you start

  • Change the tube at least 30 minutes before or 30 to 60 minutes after your child feeds. This reduces the risk of choking, coughing or breathing difficulties.
  • Make sure that the oximeter is applied and your child’s oxygen saturations are at their baseline.
  • Identify the main person and assistant roles.
  • Gather your supplies (see below).

What supplies do I need to have in place?

Your supplies include:

  • your child’s tracheostomy change kit
  • cleaning supplies kit
  • additional equipment and supplies.

Tracheostomy kit

  • Tracheostomy outer cannula with ties attached and obturator of the same size
  • Tracheostomy tube one size smaller with ties attached and obturator (store in a small, well-labelled clear bag)
  • Normal saline nebules (small, sealed tubes that are filled with saline)
  • Water soluble lubricant
  • Round-ended scissors
  • Clean tracheostomy gauze (dressing)
  • Manual suction setup: 20 mL syringe with feeding tube attached (in case the suction machine malfunctions)
Tracheostomy change kit
Images of emergency tracheostomy supplies  

Cleaning supplies

  • Gauze pads​
  • Saline soaked cotton swabs (single use)​
  • Saline nebules
  • Wet facecloth
  • Dry facecloth​
Tracheostomy cleaning supplies
Images of tracheostomy cleaning supplies listed above  

Additional equipment and supplies

Additional tracheostomy equipment and supplies
Images of additional tracheostomy equipment listed above  

How do I change the tracheostomy tube?

Caregiver speaking to child with a tracheostomy  
  1. Explain to your child what you are going to do. For babies, make sure they are calm and settled.
Caregiver washing their hands  
  1. Wash your hands.
Wrapping an oximeter probe around a toe  
  1. Make sure the oximeter probe is on your child and oxygen saturations are at their baseline. The probe may be placed on an older child's toe or finger or around a baby's foot.
Inspecting a tracheostomy tube  
  1. Inspect the clean tracheostomy tube to make sure there are no cracks or discolorations. If there are any cracks or discolorations, throw this tracheostomy tube out and use a new tracheostomy tube. Check that the tracheostomy tube is the correct size.
Checking the obturator in a tracheostomy tube  
  1. Check that the obturator goes into and out of the outer cannula smoothly and keeps the shaft of the tracheostomy tube centered.
Lubricating the cannula  
  1. Wet the inside of the outer cannula with normal saline or lubricate the obturator and place it in and out of the cannula to lubricate the cannula.
Lubricating the tracheostomy tube  
  1. Prepare the tracheostomy tube for insertion by putting a small amount of water soluble lubricant on the outside of the tube.
Placing the tracheostomy tube upright to keep it clean  
  1. Lay the tracheostomy tube down on a piece of gauze or sterile towel with shaft pointing upwards. This will keep the tube clean before insertion.
  2. Lay your child on their back. Put a roll or blanket under the child’s shoulders to tilt the head back and extend the neck. Older children may prefer to sit up, but make sure that their head and back are supported.
Suctioning a child’s tracheostomy tube  
  1. Suction the tracheostomy tube so your child's airway is clear before you insert the new tube.
Two people are needed to do a tracheostomy change  
  1. Divide the remaining tasks between the main person and assistant, as follows.
Main person
Main person removing the Velcro strap from the tracheostomy tube  

Remove the Velco strap from the tube by releasing it on one side and then the other.

Gently clean the skin and stoma (opening on the neck). It is also ok to clean the skin when the new tube is in place.

Helper
Helper person holds the child’s shoulder and tracheostomy while the main person removes the tracheostomy ties  

Hold the tracheostomy tube in place.​

Main person
Using the flanges to hold and insert a tracheostomy tube  

Pick up the clean outer cannula, holding the face plate between two fingers.

With the other hand, make sure the obturator is inside.

Helper
Holding a tracheostomy tube in place  

Make sure the tube is still in place.

Main person
Two people removing a child’s tracheostomy tube  

Support the child and keep them still.

Helper
Removing a tracheostomy tube  

Gently remove the child's old tracheostomy tube and place it on a towel designated for dirty supplies.

Main person
Wiping a tracheostomy stoma before inserting a tracheostomy tube  

Support the child and keep them still.

Helper
Wiping a tracheostomy stoma area  

Clean the area.

Wipe the stoma if there are secretions in the hole.

Main person
Placing a lubricated tracheostomy tube into a tracheostomy stoma  

Gently guide the clean tracheostomy tube into the stoma, but do not put pressure on it once it is in the trachea.

Helper
Supporting a child while replacing a tracheostomy  

Support the child and keep them still.

Main person
Inserting a tracheostomy tube  

The tube should go in easily without discomfort. It is normal for the child to cough.

Helper
Inserting a tracheostomy tube into a tracheostomy stoma  

If you cannot insert the tracheostomy tube, try using one that is a size smaller. If that does not work, follow the emergency care steps.

Main person
Pulling the obturator out of a tracheostomy tube  

Holding the clean tracheostomy tube in place, take out the obturator.

If the child uses a tracheostomy tube with an inner cannula, put it in now. Secure the tracheostomy tube in place.

Do not discard the obturator. It will be cleaned and reused, so keep it in a safe place where you can easily find it.

Helper
Supporting a child’s tracheostomy tube while removing the obturator  

​Support the child and keep them still.

Main person
Adjusting tracheostomy ties  

Hold the tracheostomy tube in place.

​Check that your child is breathing normally by putting your finger close to the tube to check that air is flowing. Also check that your child's chest is moving as they breathe.

Helper
Placing tracheostomy ties around a child’s neck  

​Support the child and keep them still.

Main person
Cleaning a child’s tracheostomy  

​Support the child and keep them still.

Helper
Wiping away from a tracheostomy stoma  

Clean and dry the skin around the stoma if you did not do so in step 1. You may need to pull the ties apart to clean around the neck.

​Once the skin is clean and dry, secure the ties. Make sure the ties are secure at the back and on each side of the flanges. Leave a one-finger gap between the ties and skin so the tube is not too tight.

Main person
Suctioning a child’s tracheostomy  

Suction the new tracheostomy tube, if needed.

Helper
Suctioning a tracheostomy tube  
Main person
Placing an HME on a tracheostomy tube  

​If your child is on oxygen or has an HME and tracheostomy mask, put it back on.

Helper
Two people helping a child with a tracheostomy  

Main person

​Clean, dry and prepare the used tracheostomy tube for the tracheostomy kit right away.

How do I change tracheostomy ties and dressings?

Keeping the tracheostomy ties clean and dry will prevent skin irritation, sores and skin infections around the neck. Ties should be changed once a day, or more often if they are dirty.

There should always be two people present when changing the ties. One person will hold the tracheostomy tube in place while the other person will clean the skin and change the ties. If a second person is not around to help, attach the clean ties before you remove the old ones.

Before you start

  • Identify and assign the main person and assistant roles.
  • Gather your supplies:
    • new tracheostomy ties
    • tweezers
    • tracheostomy gauze, if needed
    • scissors
    • suction machine, suction catheters/adjuncts and suction tubing
    • your child’s emergency tracheostomy kit
    • oximeter
    • oxygen, if applicable
    • manual resuscitation bag.

Changing Velcro tracheostomy ties

Caregiver and child with a tracheostomy  
  1. Make sure your child is in a comfortable position.
Caregiver washing their hands  
  1. Wash your hands.
Child wearing oximeter probe on thumb  
  1. Make sure the oximeter is on your child and oxygen saturations are at their baseline.
Caregivers detaching tracheostomy tube ties on child  
  1. Have the assistant hold the tracheostomy tube in place by gently holding onto the flange.
Removing tracheostomy tube ties  
  1. Remove the old Velcro tie from one side.
Placing new tracheostomy tube ties into tracheostomy tube  flange  
  1. Insert and secure the new Velcro strap into the same neck plate hole. If necessary, use the tweezers to pull the tie through the hole.
Unfastening Velcro tracheostomy  tube ties  
  1. Remove the old Velcro tie from the other side.
Inserting tracheostomy ties into flange hole 
  1. Insert and secure the new Velcro strap into the neck plate hole.
Holding tracheostomy tube in place while tracheostomy tube tie is loose  
  1. Adjust the ties to fit your child’s neck.
Checking tracheostomy tube tie fit with finger  
  1. You should be able to fit one finger between the tie and your child’s neck. Your finger should be able to go all the way around the neck.
Caregiver washing their hands  
  1. Wash your hands.

Key points

  • Regular tracheostomy tube changes help prevent mucus from building up in your child's airway and granulation tissue from forming around the tube.
  • Do a routine tracheostomy tube change at least 30 minutes before or 30 to 60 minutes after your child feeds.
  • Before changing the tracheostomy tube, gather your equipment and supplies and make sure the main person and assistant roles are clear.
  • Make sure to change the tracheostomy ties at least once a day and keep them clean and dry to prevent skin irritation and infections around the neck.

Cristina Franco, RN

Vandana Tuszynska, RN, MN

Reshma Amin, MD, FRCPC, MSc

Faiza Syed, BHSc, RRT​​

Evan Propst, MD​, FRCPC, MSc

Sara McEwan​​, RN, MN​

8/9/2017




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