Changing a Tracheostomy (Trach) Tube
The trach tube will need to be changed at least once a week or if it comes out or becomes plugged.
Trach tube comes out part of the way:
- Gently slide the same trach tube back in.
- Make sure the ties are tied securely.
- Suction as needed.
If the trach tube becomes plugged:
If your child is having trouble breathing, or it is hard to suction secretions through the catheter, the trach tube may be plugged. Try to suction. If you can not suction the trach tube or your child is still having trouble breathing, remove the trach tube and insert the clean back-up tube as you have been taught.
Equipment needed for changing a trach tube:
For routine trach changes, you will need a second person to assist you.
- Clean, backup trach tube
- Emergency size (smaller) trach tube
- Trach ties
- Rolled towel or blanket
- Soap, warm water and 2 soft cloths
- Ambu bag
- Trach dressing, if used
- Water-soluble lubricant, if used
Changing the trach:
- Wash your hands.
- Gather all supplies.
- Examine the new trach tube for cracks, ridges, or any problems. If you notice problems, throw away the trach tube. If the new trach tube has no problems, insert the obturator.
- Place your child on his/her back in a well-lit area with the rolled towel under his/her shoulders to slightly extend his/her neck.
- Remove ties while a helper holds the trach tube securely in place. Clean the trach stoma with one cloth and the neck with another cloth using soap and water. Dry the area well.
- Your helper should pull the trach tube out with a curving motion. (Don't pull it straight out.)
- Hold the new trach tube so that it curves downward.
- Gently ease the trach tube into the opening in the child's neck in a curved motion as taught. You may want to use two fingers to hold open the stoma. Your helper may need to hold the chin up or keep your child's hands out of your way.
- If the trach tube does not go in easily, reposition the child's head and neck.
- As soon as the trach tube is in place, remove the obturator and tie the ties securely.
- Suction as needed.
- Wash your hands.
If you are unable to get the trach tube back in the stoma:
- BE CALM. Moisten the trach tube with saline and attempt to put it in. If this doesn’t work, try to insert a smaller size trach tube into the trach opening.
- If unable to get the smaller trach tube in the stoma (trach opening in the neck), stay with your child and have someone call the rescue squad. If you are alone, carry your child to the phone and call for emergency assistance.
- If you can not get the trach tube into the child through the stoma you can a slip the obturator into the opening and gently pull downward to open the stoma. This may allow you to then insert the small trach tube above the obturator into the stoma.
- If you are unable to insert a new trach tube and your child is not able to breathe, cover the stoma and place the face mask of the ambu bag over your child’s nose and mouth. Squeeze the bag to give a breath once every 5 seconds (for infants less than 1 year old squeeze the bag once every 3 seconds.)
- If your child becomes unconscious begin CPR.
In an emergency, you must be ready to act. Knowing what to do and how to do it will help you remain calm and ready to act in the right way. It helps to practice emergency care on a doll with a trach. You and your family members should review this information and practice these skills. Keep the “Go-Bag” (the bag with all your emergency equipment) ready and close by at all times.
Cleaning the trach tube for reuse:
Your home is a very different place than the hospital. Below are instructions for caring for your child’s tracheostomy tube at home.
- Any clean container may be used to store trach tubes. It should have a secure top like a specimen cup or food container. A non-sterile container should be washed well with soap and water before it is used.
- Soak trach tube in soap and water at least 15 minutes after the trach change. It may soak longer but is not necessary. The trach tube must be completely covered with the soapy water while soaking.
- Rinse with tap water.
- Place trach tube and obturator on a clean surface.
- Clean the container and top thoroughly as described above. Any soap that is NON-grease cutting and has NO lanolin is fine for cleaning the trach tube and container.
- Clean the trach tube with soap and water, paying close attention to all surfaces. Using the obturator, clean the inner trach first from the top, then from the bottom to clear all plugs and mucous. The soap should be in contact with the tube for at least 1 minute.
- Rinse very, very well inside and out. Check for a clear stream of water coming through the trach tube to be sure it is not blocked. INSPECT inside and out. Place in container.
- Leave top of container off or half-covered until all moisture has dried. This could take from 8 to 24 hours. If mold is ever found, throw away the trach tube.
NOTE: Trach tubes should be thrown away 30 days after opening the box. Write the date on the box when you open a new trach tube.