Changing a tracheostomy tubeCChanging a tracheostomy tubeChanging a tracheostomy tubeEnglishRespiratoryChild (0-12 years);Teen (13-18 years)Lungs;TracheaRespiratory systemNon-drug treatmentCaregivers Adult (19+) Hospital healthcare providersNA2017-06-29T04:00:00ZReshma Amin, MD, FRCPC, MSc;Faiza Syed, BHSc, RRT;Tuyen Tran, RRT000Flat ContentHealth A-Z

 

 

Changing a tracheostomy tube2917.00000000000Changing a tracheostomy tubeChanging a tracheostomy tubeCEnglishRespiratoryChild (0-12 years);Teen (13-18 years)Lungs;TracheaRespiratory systemNon-drug treatmentCaregivers Adult (19+) Hospital healthcare providersNA2017-06-29T04:00:00ZReshma Amin, MD, FRCPC, MSc;Faiza Syed, BHSc, RRT;Tuyen Tran, RRT000Flat ContentHealth A-Z<h2>How often should a tracheostomy tube be changed?</h2><p>If there is no inner cannula, your child’s tracheostomy tube is changed once a week. In some cases, you will change the tube every two weeks.</p><p>If there is an inner cannula, your child's tracheostomy tube is changed every month. The inner cannula should be changed at least once a day.</p><p>You may also need to change the tracheostomy tube more often when your child is unwell.</p><p>Your child’s healthcare team will tell you exactly how often your child will need to have their tube changed.</p><h2>How long does it take to change a tracheostomy tube?</h2><p>Once you are familiar with the process, a routine tracheostomy tube change will take about 20 to 30 minutes from start to finish.</p><h2>How do I change my child's tracheostomy tube?</h2><p>​​Routine <a href="/Article?contentid=2916&language=English">tracheostomy tube</a> changes sho​uld be performed by two people: a main person and an assistant. In case of emergency, one person may change the tracheostomy tube.</p><p>In this section 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 your child's tracheostomy tube quickly and smoothly</a></li><li>how to <a href="#cannula">change the inner cannula for three-part tracheostomy tubes</a></li><li>how to <a href="#ties">change tracheostomy ties and dressings.</a></li></ul><div class="caution"><h3>​​Precaution</h3><p>To reduce the risk of choking, coughing or breathing difficulties, change your child's tracheostomy tube at least 30 minutes before or 30 to 60 minutes after your child feeds.</p></div><p></p><h3 id="supplies">Before you start</h3><ul><li>Identify and assign the main person and assistant roles.</li><li>Gather your supplies:</li><ul><li>your child’s tracheostomy kit</li><li>cleaning supplies</li><li>additional equipment.</li></ul></ul><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> <figure class="asset-c-100"><span class="asset-image-title">Tracheostomy kit</span><img src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachChangeKit_EN.jpg" alt="Image of tracheostomy kit supplies" /></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> <figure class="asset-c-100"> <span class="asset-image-title">Tracheostomy cleaning supplies</span><img src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachCleaningKit_EN.jpg" alt="Image of tracheostomy cleaning supplies listed above" /></figure> <p> <em>Additional equipment and supplies</em></p><ul><li>Wound care supplies, if needed.</li><li> <a href="/Article?contentid=2928&language=English">Suction machine, suction catheters/adjuncts and tubing​</a></li><li>Sterile water and container</li><li>Good light source</li><li> <a href="/Article?contentid=2945&language=English">Manual resuscitation bag</a> with tracheostomy adaptor and the appropriate sized mask</li><li> <a href="/Article?contentid=2963&language=English">Oximeter</a></li><li> <a href="/Article?contentid=2958&language=English">Oxygen</a>, if needed​</li></ul> <figure class="asset-c-100"> <span class="asset-image-title">Additional tracheostomy equipment and supplies</span><img src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachEquipKit_EN.jpg" alt="Image of additional tracheostomy equipment listed above" /> </figure> <h3 id="tube">Changing the tracheostomy tube</h3><ol class="akh-steps"><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step01_EN.jpg" alt="Caregiver speaking to child with a tracheostomy" /> </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 src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step02_EN.jpg" alt="Caregiver washing their hands" /></figure> <p>Wash your hands.<br></p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step03_EN.jpg" alt="Wrapping an oximeter probe around a toe" /> </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 src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step04_EN.jpg" alt="Inspecting a tracheostomy tube" /> </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 src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step05_EN.jpg" alt="Checking the obturator in a tracheostomy tube" /> </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 src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step06_EN.jpg" alt="Lubricating the cannula" /></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 lubricte the cannula.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step07_EN.jpg" alt="Lubricating the tracheostomy tube" /></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 src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step08_EN.jpg" alt="Placing the tracheostomy tube upright to keep it clean" /> </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>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.</li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/IMD-TrachChange-Step10_EN.jpg" alt="Suctioning a child’s tracheostomy tube" /> </figure> <p>Suction the tracheostomy tube so your child's airway is clear before you insert the new tube.</p></li><li> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_11_EN.jpg" alt="Two people are needed to do a tracheostomy change" /> </figure> <p>Divide the remaining tasks between the main person and assistant, as follows.</p></li></ol><div class="asset-4-up"> <figure> <span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_12a_EN.jpg" alt="Main person removing the Velcro strap from the tracheostomy tube" /><figcaption class="asset-image-caption">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.</figcaption></figure><figure> <span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_12b_EN.jpg" alt="Helper person holds the child’s shoulder and tracheostomy while the main person removes the tracheostomy ties" /><figcaption class="asset-image-caption">Hold the tracheostomy tube in place.</figcaption> </figure><figure><span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_14a_EN.jpg" alt="Using the flanges to hold and insert a tracheostomy tube" /><figcaption class="asset-image-caption">Pick up the clean outer cannula, holding the face plate between two fingers.<br>With the other hand, make sure the obturator is inside.</figcaption></figure><figure> <span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_14b_EN.jpg" alt="Holding a tracheostomy tube in place" /><figcaption class="asset-image-caption">Make sure the tube is still in place.</figcaption> </figure></div><div class="asset-4-up"> <figure> <span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_15aa_EN.jpg" alt="Two people removing a child’s tracheostomy tube" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption></figure><figure> <span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_15b_EN.jpg" alt="Removing a tracheostomy" /><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><figure><span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_16a_EN.jpg" alt="Wiping a tracheostomy stoma before inserting a tracheostomy tube" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption></figure><figure><span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_16b_EN.jpg" alt="Wiping a tracheostomy stoma area" /><figcaption class="asset-image-caption"> Clean the area.<br>Wipe the stoma if there are secretions in the hole.</figcaption> </figure></div><div class="asset-4-up"> <figure> <span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_12a_EN.jpg" alt="Main person removing the Velcro strap from the tracheostomy tube" /><figcaption class="asset-image-caption">Remove the Velco strap from the tube by releasing it on one side and then the other. <br>Then 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.</figcaption></figure><figure> <span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_12b_EN.jpg" alt="Helper person holds the child’s shoulder and tracheostomy while the main person removes the tracheostomy ties" /><figcaption class="asset-image-caption">Hold the tracheostomy tube in place.</figcaption></figure><figure> <span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_14a_EN.jpg" alt="Using the flanges to hold and insert a tracheostomy tube" /><figcaption class="asset-image-caption"> Pick up the clean outer cannula, holding the face plate between two fingers.<br> With the other hand, make sure the obturator is inside.</figcaption></figure><figure><span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_14b_EN.jpg" alt="Holding a tracheostomy tube in place" /><figcaption class="asset-image-caption">Make sure the tube is still in place.</figcaption></figure></div><div class="asset-4-up"> <figure> <span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_15aa_EN.jpg" alt="Two people removing a child’s tracheostomy tube" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption></figure><figure><span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_15b_EN.jpg" alt="Removing a tracheostomy" /><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><figure><span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_16a_EN.jpg" alt="Wiping a tracheostomy stoma before inserting a tracheostomy tube" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption></figure><figure><span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_16b_EN.jpg" alt="Wiping a tracheostomy stoma area" /><figcaption class="asset-image-caption">Clean the area.<br> Wipe the stoma if there are secretions in the hole.</figcaption> </figure> </div><div class="asset-4-up"> <figure> <span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_17a_EN.jpg" alt="Placing a lubricated tracheostomy tube into a tracheostomy stoma" /><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> <figure> <span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_17bb_EN.jpg" alt="Supporting a child while replacing a tracheostomy" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption></figure><figure><span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_18a_EN.jpg" alt="Inserting a tracheostomy tube" /><figcaption class="asset-image-caption">The tube should go in easily without discomfort. It is normal for the child to cough.</figcaption></figure><figure><span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_18b_EN.jpg" alt="Inserting a tracheostomy tube into a tracheostomy stoma" /><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></div><div class="asset-4-up"> <figure> <span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_19a_EN.jpg" alt="Pulling the obturator out of a tracheostomy tube" /><figcaption class="asset-image-caption">Holding the clean tracheostomy tube, take out the obturator. If the child uses a tracheostomy tube with an inner cannula, put it in now and secure the tube.<br> <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><figure><span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_19b_EN.jpg" alt="Supporting a child’s tracheostomy tube while removing the obturator" /><figcaption class="asset-image-caption">​Support the child and keep them still.</figcaption> </figure> <figure><span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_20a_EN.jpg" alt="Adjusting tracheostomy ties" /><figcaption class="asset-image-caption">Hold the tracheostomy tube in place.<br> ​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.</figcaption></figure><figure><span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_20b_EN.jpg" alt="Placing tracheostomy ties around a child’s neck" /><figcaption class="asset-image-caption">​Support the child and keep them still.</figcaption></figure></div><div class="asset-4-up"> <figure> <span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_21aa_EN.jpg" alt="Cleaning a child’s tracheostomy stoma" /><figcaption class="asset-image-caption">Support the child and keep them still.</figcaption></figure><figure><span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_21b_EN.jpg" alt="Wiping away from a tracheostomy stoma" /><figcaption class="asset-image-caption">Clean and dry the skin around the stoma if you did not before. If needed, pull the ties apart to clean around the neck.<br> ​Once the skin is clean and dry, secure the ties at the back <em>and</em> on each side of the flanges. Leave a one-finger gap between the ties and skin.<br></figcaption></figure><figure><span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_22a_EN.jpg" alt="Suctioning a child’s tracheostomy" /><figcaption class="asset-image-caption">Suction the new tracheostomy tube, if needed.</figcaption> </figure> <figure> <span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_22b_EN.jpg" alt="Suctioning a tracheostomy tube" /></figure></div><div class="asset-2-up"> <figure> <span class="asset-image-title">Main person</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_23a_EN.jpg" alt="Placing an HME on a tracheostomy" /><figcaption class="asset-image-caption">If your child is on oxygen or has an HME and tracheostomy mask, put it back on.</figcaption></figure><figure><span class="asset-image-title">Helper</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_change_23b_EN.jpg" alt="Two people helping a child with a tracheostomy" /> </figure></div><h3>Main p​erson</h3> ​​ <p>Clean, dry and prepare the used tracheostomy tube for the tracheostomy kit right away.</p><h2 id="cannula">How do I change the inner cannula for three-part tracheostomy tubes?</h2><p>For children using a three-part tracheostomy tube, the inner cannula needs to be changed two or three times a day.</p><h3>Before you start</h3><p>Gather your supplies: </p><ul><li>sterile inner cannula (disposable or reusable)</li><li>clean basin or bowl </li><li>emergency tracheostomy kit (see below)</li><li>suction machine, suction catheters/adjuncts and tubing</li><li>oximeter</li><li>oxygen, if needed</li> <li>manual resuscitation bag.</li></ul><p> <em>Emergency tracheostomy kit</em></p><ul><li>Spare 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> <figure class="asset-c-100"><span class="asset-image-title">Emergency tracheostomy kit</span><img src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachChangeKit_EN.jpg" alt="Image of emergency tracheostomy supplies listed above" /> </figure> <p>Some of the items in your kit may need to be replaced after use. Remember to keep the kit stocked with fresh nebules, suction catheters, gauze, sterile water and other one-time-use items.</p><p>If you are using a reusable inner cannula, wash it according to the <a href="/Article?contentid=2918&language=English">tracheostomy equipment cleaning instructions​</a>. If you are using a disposable inner cannula, discard it after each use and replace it with a new disposable inner cannula for the next tube change.</p><h3>Changing the tube</h3> <figure> <span class="asset-image-title">Three-part tracheostomy tube with reusable inner cannula</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_inner_cannula_EN.jpg" alt="The inner and outer cannulas showing the size stamp and alignment of dots used to lock it in place" /><figcaption class="asset-image-caption">Lock the inner cannula into the outer cannula by twisting it and lining up the dots. Make sure the cannulas are the same size.</figcaption> </figure> <ol><li>Wash your hands.</li><li>Make sure the oximeter is on your child and oxygen saturations are at their baseline.</li><li>Suction your child to remove secretions, if needed. Monitor oxygen saturation.</li><li>Remove the new inner cannula from its packaging or storage container according to the manufacturer’s instructions.</li><li>Hold the neck plate securely with one hand. With the other hand, gently remove the used inner cannula using a curved downward motion.</li><li>If the used cannula is disposable, discard it. If it is reusable, place it to one side for cleaning.</li><li>Suction to remove secretions, if needed. If your child is able to clear the secretions with coughing, suctioning may not be needed.</li> <figure> <span class="asset-image-title">Three-part tracheostomy tube with disposable inner cannula</span><img src="https://assets.aboutkidshealth.ca/akhassets/trach_inner_cannula_hold_EN.jpg" alt="Fingers holding each flange of the tracheostomy to change the inner cannula" /><figcaption class="asset-image-caption">Hold the neck flange of the tracheostomy tube when changing the inner cannula. To release the inner cannula and lock a new one into place, squeeze the outer edges.</figcaption></figure> <li>Hold the neck plate securely with one hand. With the other hand, gently insert the new inner cannula using a curved upward motion. Lock in place or squeeze the sides to secure.</li><li>Clean the area.</li><li>Wash your hands.</li></ol><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 infections in the skin around the neck. Ties should be changed daily 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 cleans the skin and changes the ties. If a second person is not around to help, attach the clean ties first and then remove the old ties.</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 src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_01.jpg" alt="Caregiver and child with a tracheostomy" /> </figure> <p>Make sure your child is in a comfortable position.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_02.jpg" alt="Caregiver washing their hands" /> </figure> <p>Wash your hands.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_03.jpg" alt="Child wearing oximeter probe on thumb" /> </figure> <p>Make sure the oximeter is on your child and oxygen saturations are at their baseline.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_04.jpg" alt="Caregivers detaching tracheostomy tube ties on child" /> </figure> <p>Have the assistant hold the tracheostomy tube in place by gently holding onto the flange.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_05.jpg" alt="Removing tracheostomy tube ties" /> </figure> <p>Remove the old Velcro tie from one side.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_06.jpg" alt="Placing new tracheostomy tube ties into tracheostomy tube flange" /> </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 src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_07.jpg" alt="Unfastening Velcro tracheostomy tube ties" /> </figure> <p>Remove the old Velcro tie from the other side.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_08.jpg" alt="Inserting tracheostomy ties into flange hole" /> </figure> <p>Insert and secure the new Velcro strap into the neck plate hole.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_09.jpg" alt="Holding tracheostomy tube in place while tracheostomy tube tie is loose" /> </figure> <p>Adjust the ties to fit your child’s neck.</p></li><li> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_09b.jpg" alt="Checking tracheostomy tube tie fit with finger" /> </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 src="https://assets.aboutkidshealth.ca/akhassets/trach_ties_change_02.jpg" alt="Caregiver washing their hands" /> </figure> <p>Wash your hands.</p></li></ol> <a class="btn btn-primary" href="https://www.aboutkidshealth.ca/trachvent">Return to trach-vent learning hub</a><br>Changing a tracheostomy tubeTruehttps://www.aboutkidshealth.ca/Article?contentid=2918&language=Englishhttps://www.aboutkidshealth.ca/Article?contentid=2916&language=English

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