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The surgeon will perform the first tracheostomy tube change to ensure that the stoma and tracheostomy site heal properly. If the stoma is ready (usually 1-2 weeks after surgery), the otolaryngology team will teach the caregivers how perform a tube change. It is important that caregivers feel confident and competent in tube changing before leaving the hospital in case an emergency tube change is needed. The procedure is not without risks and in order to be as safe as possible, it is important to have two people present.
Secretions from the lungs coat the inside of the tracheostomy tube requiring the tube to be changed once a week, although some patients may be fitted with a different tube that can be left in longer. The tube may have to be changed more often if secretions become very dry or if the patient has a chest infection and is producing more and thicker secretions. Always change the trach tube before a feeding or wait for at least two hours after a feeding to avoid vomiting and resulting spillage of vomitus into the windpipe.
Instructions for tube changing
- Prepare equipment:
- Suction catheter and suction machine in working order
- two lengths of 1/4 inch cotton tapes or Velcro strap
- new tube - check correct size and that the tube is intact and in good order
- a smaller sized tube (one incremental size smaller) in case the usual one will not go in
- water-based lubricant to prevent the tube sticking to the skin as it is inserted
- round-ended scissors
- Wash your hands.
- Prepare tube - take out of wrapping and hold by the flanges. Put in introducer (if applicable). Carefully apply a small amount of lubricant to the outer side of the end of the tube, ensuring no lubricant gets into the ends of the tube. Place the ties or strap on the new tube. Place the tube on the wrapper.
- Have all equipment within easy reach.
- Suction if necessary.
- Position the patient as you do for tape changing.
- Have one person hold the tube while the other cuts and remove the dirty tapes and place clean tapes behind the patient’s neck.
- The tube should continue to be held while the other person holds the new tube by the flanges and positions the tip near the patient’s neck.
- Gently remove the old tube following the curve of the tube.
- Firmly and gently slide in the new tube, again following the curve of the tube so as not to damage the trachea. Remove introducer if this has been used.
- Hold the new tube securely in place - changing the tube may cause the patient to cough, which could dislodge it.
- Allow the coughing to settle. Check air flow through the tracheostomy tube by feeling the air flow onto your hands and the patient’s breathing pattern and color. Suction if necessary.
- Clean and observe the skin around the tube.
- Tie the tapes.
- Do not let go of the tube until the tapes are secure.