Tracheostomy: How to change your child's tracheostomy tubeTTracheostomy: How to change your child's tracheostomy tubeTracheostomy: How to change your child's tracheostomy tubeEnglishRespiratoryChild (0-12 years);Teen (13-18 years)TracheaTracheaNon-drug treatmentCaregivers Adult (19+)NA2017-08-09T04:00:00ZCristina Franco, RN;Vandana Tuszynska, RN, MN;Reshma Amin, MD, FRCPC, MSc;Faiza Syed, BHSc, RRT​​;Evan Propst, MD​, FRCPC, MSc;Sara McEwan​​, RN, MN​6.0000000000000071.00000000000001561.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn step-by-step instructions for changing your child's tracheostomy tube and Velcro tube ties.</p><p>Once your child has a tracheostomy tube inserted, you will need to change it regularly.</p> <p>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 on the surface of a cut or incision, or may be a reaction to the plastic in the tracheostomy tube.</p> <p>You will also need to change your child’s tracheostomy tube <a href="/Article?contentid=2470&language=English">in case of emergency</a>, for instance if your child has trouble breathing or the tube accidentally falls out.</p><h2>Key points</h2> <ul> <li>Regular tracheostomy tube changes help prevent mucus from building up in your child's airway and granulation tissue from forming around the tube. </li> <li>Do a routine tracheostomy tube change at least 30 minutes before or 30 to 60 minutes after your child feeds.</li> <li>Before changing the tracheostomy tube, gather your equipment and supplies and make sure the main person and assistant roles are clear. </li> <li>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.</li> </ul><h2 id="tube">How do I change the tracheostomy tube?</h2><ol class="akh-steps"><li> <figure> <img alt="Caregiver speaking to child with a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step01_EN.jpg" /> </figure> <p>Explain to your child what you are going to do. For babies, make sure they are calm and settled.</p></li><li> <figure> <img alt="Caregiver washing their hands." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step02_EN.jpg" /> </figure> <p>Wash your hands.</p></li><li> <figure> <img alt="Wrapping an oximeter probe around a toe." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step03_EN.jpg" /> </figure> <p>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.</p></li><li> <figure> <img alt="Inspecting a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step04_EN.jpg" /> </figure> <p>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.</p></li><li> <figure> <img alt="Checking the obturator in a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step05_EN.jpg" /> </figure> <p>Check that the obturator goes into and out of the outer cannula smoothly and keeps the shaft of the tracheostomy tube centered.</p></li><li> <figure> <img alt="Lubricating the cannula." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step06_EN.jpg" /> </figure> <p>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.</p></li><li> <figure> <img alt="Lubricating the tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step07_EN.jpg" /> </figure> <p>Prepare the tracheostomy tube for insertion by putting a small amount of water soluble lubricant on the outside of the tube.</p></li><li> <figure> <img alt="Placing the tracheostomy tube upright to keep it clean." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step08_EN.jpg" /> </figure> <p>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.</p></li><li><p>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.</p></li><li> <figure> <img alt="Suctioning a child’s tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step10_EN.jpg" /> </figure> <p>Suction the tracheostomy tube so your child's airway is clear before you insert the new tube.</p></li><li> <figure> <img alt="Two people are needed to do a tracheostomy change." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_11_EN.jpg" /> </figure> <p>Divide the remaining tasks between the main person and assistant, as follows.</p> <br> </li></ol> <table class="akh-table"><tbody></tbody><thead><tr><th>Main person</th><th>Helper</th></tr></thead><tbody><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Main person removing the Velcro strap from the tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_12a_EN.jpg" /><figcaption class="asset-image-caption"> <p>Remove the Velco strap from the tube by releasing it on one side and then the other.</p> <p>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.</p></figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Helper person holds the child’s shoulder and tracheostomy while the main person removes the tracheostomy ties." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_12b_EN.jpg" /><figcaption class="asset-image-caption">Hold the tracheostomy tube in place.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Using the flanges to hold and insert a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_14a_EN.jpg" /><figcaption class="asset-image-caption"> <p>Pick up the clean outer cannula, holding the face plate between two fingers.</p> <p>With the other hand, make sure the obturator is inside.</p></figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Holding a tracheostomy tube in place." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_14b_EN.jpg" /><figcaption class="asset-image-caption">Make sure the tube is still in place.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Two people removing a child’s tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_15aa_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Removing a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_15b_EN.jpg" /><figcaption class="asset-image-caption">Gently remove the child's old tracheostomy tube and place it on a towel designated for dirty supplies.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Wiping a tracheostomy stoma before inserting a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_16a_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Wiping a tracheostomy stoma area." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_16b_EN.jpg" /><figcaption class="asset-image-caption"> <p>Clean the area.</p> <p>Wipe the stoma if there are secretions in the hole.</p></figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Placing a lubricated tracheostomy tube into a tracheostomy stoma." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_17a_EN.jpg" /><figcaption class="asset-image-caption">Gently guide the clean tracheostomy tube into the stoma, but do not put pressure on it once it is in the trachea.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Supporting a child while replacing a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_17bb_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Inserting a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_18a_EN.jpg" /><figcaption class="asset-image-caption">The tube should go in easily without discomfort. It is normal for the child to cough.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Inserting a tracheostomy tube into a tracheostomy stoma." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_18b_EN.jpg" /><figcaption class="asset-image-caption">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.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Pulling the obturator out of a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_19a_EN.jpg" /><figcaption class="asset-image-caption"> <p>Holding the clean tracheostomy tube in place, take out the obturator.</p> <p>If the child uses a tracheostomy tube with an inner cannula, put it in now. Secure the tracheostomy tube in place.</p> <p>Do not discard the obturator. It will be cleaned and reused, so keep it in a safe place where you can easily find it.</p></figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Supporting a child’s tracheostomy tube while removing the obturator." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_19b_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Adjusting tracheostomy ties." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_20a_EN.jpg" /><figcaption class="asset-image-caption"> <p>Hold the tracheostomy tube in place.</p> <p>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.</p></figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Placing tracheostomy ties around a child’s neck." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_20b_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Cleaning a child’s tracheostomy stoma." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_21aa_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Wiping away from a tracheostomy stoma." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_21b_EN.jpg" /><figcaption class="asset-image-caption"> <p>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.</p> <p>Once the skin is clean and dry, secure the ties. Make sure the ties are secure at the back <em>and</em> on each side of the flanges. Leave a one-finger gap between the ties and skin so the tube is not too tight.</p></figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Suctioning a child’s tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_22a_EN.jpg" /><figcaption class="asset-image-caption">Suction the new tracheostomy tube, if needed.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Suctioning a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_22b_EN.jpg" /> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Placing an HME on a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_23a_EN.jpg" /><figcaption class="asset-image-caption">If your child is on oxygen or has an HME and tracheostomy mask, put it back on.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Two people helping a child with a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_23b_EN.jpg" /> </figure></td></tr></tbody></table><h3>Main person</h3><p>Clean, dry and prepare the used tracheostomy tube for the tracheostomy kit right away.</p><h2 id="supplies">What supplies do I need to have in place?</h2><p>Your supplies include:</p><ul><li>your child’s tracheostomy change kit</li><li>cleaning supplies kit</li><li>additional equipment and supplies</li></ul><div class="akh-series"><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Tracheostomy change kit</span><img alt="Images of tracheostomy supplies." src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachChangeKit_EN.jpg" /> </figure> <p> <em>Tracheostomy kit</em></p><ul><li>Tracheostomy outer cannula with ties attached and obturator of the same size</li><li>Tracheostomy tube one size smaller with ties attached and obturator (store in a small, well-labelled clear bag)</li><li>Normal saline nebules (small, sealed tubes that are filled with saline)</li><li>Water soluble lubricant</li><li>Round-ended scissors</li><li>Clean tracheostomy gauze (dressing)</li><li>Manual suction setup: 20 mL syringe with feeding tube attached (in case the suction machine malfunctions)</li></ul></div></div><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Tracheostomy cleaning supplies</span><img alt="Images of tracheostomy cleaning supplies listed above." src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachCleaningKit_EN.jpg" /> </figure> <p> <em>Cleaning supplies</em></p><ul><li>Gauze pads</li><li>Saline soaked cotton swabs (single use)</li><li>Saline nebules</li><li>Wet facecloth</li><li>Dry facecloth</li></ul></div></div><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Additional tracheostomy equipment and supplies</span><img alt="Images of additional tracheostomy equipment listed above." src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachEquipKit_EN.jpg" /> </figure> <p> <em>Additional equipment and supplies</em></p><ul><li>Wound care supplies, if needed.</li><li> <a href="/article?contentid=2469&language=English"> Suction machine, suction catheters/adjuncts and tubing</a></li><li>Sterile water and container</li><li>Good light source</li><li>Manual resuscitation bag with tracheostomy adaptor and the appropriate sized mask</li><li>Oximeter</li><li>Oxygen, if needed</li></ul></div></div></div>

 

 

Tracheostomy: How to change your child's tracheostomy tube2467.00000000000Tracheostomy: How to change your child's tracheostomy tubeTracheostomy: How to change your child's tracheostomy tubeTEnglishRespiratoryChild (0-12 years);Teen (13-18 years)TracheaTracheaNon-drug treatmentCaregivers Adult (19+)NA2017-08-09T04:00:00ZCristina Franco, RN;Vandana Tuszynska, RN, MN;Reshma Amin, MD, FRCPC, MSc;Faiza Syed, BHSc, RRT​​;Evan Propst, MD​, FRCPC, MSc;Sara McEwan​​, RN, MN​6.0000000000000071.00000000000001561.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn step-by-step instructions for changing your child's tracheostomy tube and Velcro tube ties.</p><p>Once your child has a tracheostomy tube inserted, you will need to change it regularly.</p> <p>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 on the surface of a cut or incision, or may be a reaction to the plastic in the tracheostomy tube.</p> <p>You will also need to change your child’s tracheostomy tube <a href="/Article?contentid=2470&language=English">in case of emergency</a>, for instance if your child has trouble breathing or the tube accidentally falls out.</p><h2>How often should I change my child’s tracheostomy tube?</h2> <p>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.</p> <h2>How long does it take to change a tracheostomy tube?</h2> <p>Once you are familiar with the process, a routine tracheostomy change will take about 20 to 30 minutes from start to finish.</p> <h2>Can I change my child’s tracheostomy tube on my own?</h2> <p>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. </p> <p>Below, you will learn:</p> <ul> <li>which <a href="#supplies">supplies to gather before you start</a></li> <li>how to <a href="#tube">change the tracheostomy tube quickly and smoothly</a></li> <li>how to <a href="#ties">change tracheostomy ties and dressings.</a></li> </ul> <h3>Before you start</h3> <ul> <li>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.</li> <li>Make sure that the oximeter is applied and your child’s oxygen saturations are at their baseline.</li> <li>Identify the main person and assistant roles.</li> <li>Gather your supplies (see below).</li> </ul><h2>Key points</h2> <ul> <li>Regular tracheostomy tube changes help prevent mucus from building up in your child's airway and granulation tissue from forming around the tube. </li> <li>Do a routine tracheostomy tube change at least 30 minutes before or 30 to 60 minutes after your child feeds.</li> <li>Before changing the tracheostomy tube, gather your equipment and supplies and make sure the main person and assistant roles are clear. </li> <li>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.</li> </ul><h2 id="tube">How do I change the tracheostomy tube?</h2><ol class="akh-steps"><li> <figure> <img alt="Caregiver speaking to child with a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step01_EN.jpg" /> </figure> <p>Explain to your child what you are going to do. For babies, make sure they are calm and settled.</p></li><li> <figure> <img alt="Caregiver washing their hands." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step02_EN.jpg" /> </figure> <p>Wash your hands.</p></li><li> <figure> <img alt="Wrapping an oximeter probe around a toe." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step03_EN.jpg" /> </figure> <p>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.</p></li><li> <figure> <img alt="Inspecting a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step04_EN.jpg" /> </figure> <p>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.</p></li><li> <figure> <img alt="Checking the obturator in a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step05_EN.jpg" /> </figure> <p>Check that the obturator goes into and out of the outer cannula smoothly and keeps the shaft of the tracheostomy tube centered.</p></li><li> <figure> <img alt="Lubricating the cannula." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step06_EN.jpg" /> </figure> <p>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.</p></li><li> <figure> <img alt="Lubricating the tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step07_EN.jpg" /> </figure> <p>Prepare the tracheostomy tube for insertion by putting a small amount of water soluble lubricant on the outside of the tube.</p></li><li> <figure> <img alt="Placing the tracheostomy tube upright to keep it clean." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step08_EN.jpg" /> </figure> <p>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.</p></li><li><p>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.</p></li><li> <figure> <img alt="Suctioning a child’s tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step10_EN.jpg" /> </figure> <p>Suction the tracheostomy tube so your child's airway is clear before you insert the new tube.</p></li><li> <figure> <img alt="Two people are needed to do a tracheostomy change." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_11_EN.jpg" /> </figure> <p>Divide the remaining tasks between the main person and assistant, as follows.</p> <br> </li></ol> <table class="akh-table"><tbody></tbody><thead><tr><th>Main person</th><th>Helper</th></tr></thead><tbody><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Main person removing the Velcro strap from the tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_12a_EN.jpg" /><figcaption class="asset-image-caption"> <p>Remove the Velco strap from the tube by releasing it on one side and then the other.</p> <p>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.</p></figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Helper person holds the child’s shoulder and tracheostomy while the main person removes the tracheostomy ties." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_12b_EN.jpg" /><figcaption class="asset-image-caption">Hold the tracheostomy tube in place.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Using the flanges to hold and insert a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_14a_EN.jpg" /><figcaption class="asset-image-caption"> <p>Pick up the clean outer cannula, holding the face plate between two fingers.</p> <p>With the other hand, make sure the obturator is inside.</p></figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Holding a tracheostomy tube in place." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_14b_EN.jpg" /><figcaption class="asset-image-caption">Make sure the tube is still in place.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Two people removing a child’s tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_15aa_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Removing a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_15b_EN.jpg" /><figcaption class="asset-image-caption">Gently remove the child's old tracheostomy tube and place it on a towel designated for dirty supplies.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Wiping a tracheostomy stoma before inserting a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_16a_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Wiping a tracheostomy stoma area." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_16b_EN.jpg" /><figcaption class="asset-image-caption"> <p>Clean the area.</p> <p>Wipe the stoma if there are secretions in the hole.</p></figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Placing a lubricated tracheostomy tube into a tracheostomy stoma." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_17a_EN.jpg" /><figcaption class="asset-image-caption">Gently guide the clean tracheostomy tube into the stoma, but do not put pressure on it once it is in the trachea.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Supporting a child while replacing a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_17bb_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Inserting a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_18a_EN.jpg" /><figcaption class="asset-image-caption">The tube should go in easily without discomfort. It is normal for the child to cough.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Inserting a tracheostomy tube into a tracheostomy stoma." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_18b_EN.jpg" /><figcaption class="asset-image-caption">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.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Pulling the obturator out of a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_19a_EN.jpg" /><figcaption class="asset-image-caption"> <p>Holding the clean tracheostomy tube in place, take out the obturator.</p> <p>If the child uses a tracheostomy tube with an inner cannula, put it in now. Secure the tracheostomy tube in place.</p> <p>Do not discard the obturator. It will be cleaned and reused, so keep it in a safe place where you can easily find it.</p></figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Supporting a child’s tracheostomy tube while removing the obturator." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_19b_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Adjusting tracheostomy ties." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_20a_EN.jpg" /><figcaption class="asset-image-caption"> <p>Hold the tracheostomy tube in place.</p> <p>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.</p></figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Placing tracheostomy ties around a child’s neck." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_20b_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Cleaning a child’s tracheostomy stoma." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_21aa_EN.jpg" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Wiping away from a tracheostomy stoma." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_21b_EN.jpg" /><figcaption class="asset-image-caption"> <p>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.</p> <p>Once the skin is clean and dry, secure the ties. Make sure the ties are secure at the back <em>and</em> on each side of the flanges. Leave a one-finger gap between the ties and skin so the tube is not too tight.</p></figcaption> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Suctioning a child’s tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_22a_EN.jpg" /><figcaption class="asset-image-caption">Suction the new tracheostomy tube, if needed.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Suctioning a tracheostomy tube." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_22b_EN.jpg" /> </figure></td></tr><tr><td> <figure><span class="asset-image-title">Main person</span><img alt="Placing an HME on a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_23a_EN.jpg" /><figcaption class="asset-image-caption">If your child is on oxygen or has an HME and tracheostomy mask, put it back on.</figcaption> </figure></td><td> <figure><span class="asset-image-title">Helper</span><img alt="Two people helping a child with a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_change_23b_EN.jpg" /> </figure></td></tr></tbody></table><h3>Main person</h3><p>Clean, dry and prepare the used tracheostomy tube for the tracheostomy kit right away.</p><h2 id="ties">How do I change tracheostomy ties and dressings?</h2><p>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.</p><p>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.</p><h3>Before you start</h3><ul><li>Identify and assign the main person and assistant roles.</li><li>Gather your supplies:</li><ul><li>new tracheostomy ties</li><li>tweezers</li><li>tracheostomy gauze, if needed</li><li>scissors</li><li>suction machine, suction catheters/adjuncts and suction tubing</li><li>your child’s emergency tracheostomy kit</li><li>oximeter</li><li>oxygen, if applicable</li><li>manual resuscitation bag.</li></ul></ul><h3>Changing Velcro tracheostomy ties</h3><ol class="akh-steps"><li> <figure><img alt="Caregiver and child with a tracheostomy." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_01.jpg" /> </figure> <p>Make sure your child is in a comfortable position.</p></li><li> <figure><img alt="Caregiver washing their hands." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_02.jpg" /> </figure> <p>Wash your hands.</p></li><li> <figure><img alt="Child wearing oximeter probe on thumb." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_03.jpg" /> </figure> <p>Make sure the oximeter is on your child and oxygen saturations are at their baseline.</p></li><li> <figure><img alt="Caregivers detaching tracheostomy tube ties on child." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_04.jpg" /> </figure> <p>Have the assistant hold the tracheostomy tube in place by gently holding onto the flange.</p></li><li> <figure><img alt="Removing tracheostomy tube ties." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_05.jpg" /> </figure> <p>Remove the old Velcro tie from one side.</p></li><li> <figure><img alt="Placing new tracheostomy tube ties into tracheostomy tube flange." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_06.jpg" /> </figure> <p>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.</p></li><li> <figure><img alt="Unfastening Velcro tracheostomy tube ties." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_07.jpg" /> </figure> <p>Remove the old Velcro tie from the other side.</p></li><li> <figure><img alt="Inserting tracheostomy ties into flange hole." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_08.jpg" /> </figure> <p>Insert and secure the new Velcro strap into the neck plate hole.</p></li><li> <figure><img alt="Holding tracheostomy tube in place while tracheostomy tube tie is loose." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_09.jpg" /> </figure> <p>Adjust the ties to fit your child’s neck.</p></li><li> <figure><img alt="Checking tracheostomy tube tie fit with finger." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_09b.jpg" /> </figure> <p>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.</p></li><li> <figure><img alt="Caregiver washing their hands." src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_02.jpg" /> </figure> <p>Wash your hands.</p><br></li></ol><h2 id="supplies">What supplies do I need to have in place?</h2><p>Your supplies include:</p><ul><li>your child’s tracheostomy change kit</li><li>cleaning supplies kit</li><li>additional equipment and supplies</li></ul><div class="akh-series"><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Tracheostomy change kit</span><img alt="Images of tracheostomy supplies." src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachChangeKit_EN.jpg" /> </figure> <p> <em>Tracheostomy kit</em></p><ul><li>Tracheostomy outer cannula with ties attached and obturator of the same size</li><li>Tracheostomy tube one size smaller with ties attached and obturator (store in a small, well-labelled clear bag)</li><li>Normal saline nebules (small, sealed tubes that are filled with saline)</li><li>Water soluble lubricant</li><li>Round-ended scissors</li><li>Clean tracheostomy gauze (dressing)</li><li>Manual suction setup: 20 mL syringe with feeding tube attached (in case the suction machine malfunctions)</li></ul></div></div><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Tracheostomy cleaning supplies</span><img alt="Images of tracheostomy cleaning supplies listed above." src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachCleaningKit_EN.jpg" /> </figure> <p> <em>Cleaning supplies</em></p><ul><li>Gauze pads</li><li>Saline soaked cotton swabs (single use)</li><li>Saline nebules</li><li>Wet facecloth</li><li>Dry facecloth</li></ul></div></div><div class="row"><div class="col-md-12"> <figure><span class="asset-image-title">Additional tracheostomy equipment and supplies</span><img alt="Images of additional tracheostomy equipment listed above." src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachEquipKit_EN.jpg" /> </figure> <p> <em>Additional equipment and supplies</em></p><ul><li>Wound care supplies, if needed.</li><li> <a href="/article?contentid=2469&language=English"> Suction machine, suction catheters/adjuncts and tubing</a></li><li>Sterile water and container</li><li>Good light source</li><li>Manual resuscitation bag with tracheostomy adaptor and the appropriate sized mask</li><li>Oximeter</li><li>Oxygen, if needed</li></ul></div></div></div>https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachCleaningKit_EN.jpgTracheostomy: How to change your child's tracheostomy tube

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