Change of Tracheostomy Tube
return to:Tracheotomy - Tracheostomy
- To ensure the patency of the tube, promote hygiene, and minimize the potential for infection.
- Appropriate size sterile tracheostomy tube with ties/Velcro strap
- Sterile tracheostomy dressing/drain sponge
- Sterile gloves, drape, basin, and scissors
- Sterile saline solution or water-soluble lubricant
- Sterile 10 cc syringe
PROCEDURE (video demonstration of tracheotomy change)
- Explain the procedure to the patient.
- Wash hands thoroughly.
- Unfold drape on dry surface.
- Place the tracheostomy tube and a small amount of lubricant or basin of saline solution on sterile drape.
- Position the patient supine with a pillow under shoulders to hyperextend the neck.
- Insert tracheostomy tie through slit in the flange of the outer cannula.
- Ensure that the obturator and inner cannula properly fit the outer cannula. If a cuffed tracheostomy tube is used, assess the integrity of the cuff. Refer to package instructions for specific information.
- Place the obturator in the outer cannula.
- Lubricate the tip of the obturator and outer cannula with sterile saline solution or water-soluble lubricant.
- Ensure that the tracheostomy cuff of the tube to be removed is deflated.
- While holding the tracheostomy tube in place, cut the ties of the tube to be removed.
- Remove the tracheostomy tube from the stoma and immediately insert the sterile tracheostomy tube. During insertion, the obturator should be held securely inside the outer cannula.
- After insertion of the tube, withdraw the obturator immediately.
- Secure the tie in a triple knot at the side of the neck. Tension of tie should allow for easy placement of an index finger underneath the tie. A Velcro tracheostomy tube strap is another option.
- Insert the inner cannula and lock in place.
- Inflate the tracheostomy cuff (if ordered).
- Place the sterile tracheostomy dressing/drain sponge next to the skin surface under the neck plate.
- Ensure that the obturator is readily available for reinsertion of the tube if displaced.
- Discard disposable equipment.
- Wash hands thoroughly.
PRECAUTIONS, CONSIDERATIONS, AND OBSERVATIONS
- The patient's airway should be cleared by coughing or suctioning prior to changing the tracheostomy tube.
- The obturator is to remain with the patient at all times.
- A second complete sterile tracheostomy tube of the same size should be readily available.
- The first tracheostomy tube change should be performed by the physician after 3 to 5 days when the tract is well formed. Thereafter, the tube may be changed by a registered nurse for the following indications:
- Physician order
- Weekly tracheostomy change for hygiene measures
- Faulty tracheostomy tube cuff
- Occluded outer cannula that cannot be cleared with suction
- An alternate style or size of tube is required
- It is recommended that a second nursing staff member be present during the tracheostomy tube change.
- In an emergency, the tracheal airway can be maintained with a nasal speculum, hemostat, trachea stoma spreader, endotracheal tube, or suction catheter. The adult patient should be positioned with the neck hyperextended until the tracheostomy tube can be reinserted.