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.<br></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.<br></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></li></ol><div class="asset-4-up"> <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">Remove the Velcro 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 alt="Helper 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><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">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 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> </div><div class="asset-4-up"> <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> <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> <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> <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"> 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 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><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> <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> <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> </div><div class="asset-4-up"> <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">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> Do not discard the obturator. It will be cleaned and reused, so keep it in a safe place where you can easily find it.</figcaption></figure> <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> <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">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.</figcaption> </figure><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> </div><div class="asset-4-up"> <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> <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">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.</figcaption></figure> <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><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> </div><div class="asset-2-up"> <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><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></div><h3>Main p​erson</h3> ​​ <p>Clean, dry and prepare the used tracheostomy tube for the tracheostomy kit right away.</p> <br><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><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 does not work)</li></ul> <figure class="asset-c-100"><span class="asset-image-title">Tracheostomy change kit</span><img alt="Tracheostomy kit supplies listed above" src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachChangeKit_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> <figure class="asset-c-100"><span class="asset-image-title">Tracheostomy cleaning supplies</span> <img alt="Tracheostomy cleaning supplies listed above" src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachCleaningKit_EN.jpg" /> </figure> <p> <em>Additional equipment and supplies</em></p><ul><li>Wound care supplies, if needed<br></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 size mask</li><li>Oximeter<br></li><li>Oxygen, if needed</li></ul> <figure class="asset-c-100"><span class="asset-image-title">Additional tracheostomy equipment and supplies</span><img alt="Additional tracheostomy equipment listed above" src="https://assets.aboutkidshealth.ca/akhassets/_IMD_TrachEquipKit_EN.jpg" /></figure>

 

 

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