How to Change a Tracheotomy Tube

Review of some “philosophy”

Ideally, the person wearing a tracheotomy tube will do his or her own tracheotomy tube changes and cleaning. This fosters a better frame of mind in the person wearing the tube, and in caregivers.  It is also a safety issue; in case the tube must be changed with nobody else around.

Hospital management of tracheotomy tubes is more complicated: Nurses will teach you to use gloves, sterile saline, and that each tracheotomy tube is used only once. That is, at the time of tracheotomy tube change in hospital, the old tube would just be thrown away. Hospital teaching of use of a suction machine and catheter down the trach is also routine.

By contrast, at home we often just clean the “dirty” trach with water and peroxide and re-use it.  And we can do tracheotomy changes with clean hands and tap water. Furthermore, if you have a strong cough, you may not need suction at home; equally effective can be saline instilled into the trach to help you cough and clear the device.

Our general guideline is to change the entire tracheotomy tube weekly. The inner cannula is removed and cleaned twice a day and as needed. Self-suction at home is Saline often replaced by saline squirted into the tracheotomy several times a day to keep secretions cleared away, especially in Winter.  

Some people change the entire tube as often as daily, and others, as infrequently as every few months. Some flexibility according to your own circumstance is appropriate.

Steps to total tracheotomy change

  1. Set up the place where the change will take place, typically in a bathroom. Needed: wall mirror, sink, and a clean working surface (often covered by a clean cloth towel, paper towel, etc.) Depending on your level of skill and experience, an “assistant” or “supervisor” may be needed.
  2. Separate your work surface into two areas with separate paper or cloth towels.  One will be designated “dirty,” and the other “clean.”
  3. Wash your hands thoroughly.
  4. Open the new tracheotomy tube onto the “clean” towel. It has 3 parts: outer cannula, inner cannula, and obturator. Place the obturator within the outer cannula.
  5. Fill the large cup, or bowl you use for cleaning the “dirty” trach with 1/3 hydrogen peroxide and 2/3 tap water. Place it in the “old” area of your work surface.
  6. Attach the tie or Velcro strap to the outer cannula of the “new” or “clean” trach.
  7. Position yourself in front of the mirror.
  8. Remove the “old” tracheotomy tube, following the curved arc of the tube itself. (It comes forward and rolls a bit downward.) Lay it on the “old” area of your work surface. If needed, take a few seconds to clean the area briefly around the tracheotomy opening on your neck, but try to move to step 10 within 15 seconds or so, as the opening can become smaller within a few minutes.
  9. Pick up the “new” tube (outer cannula + obturator), wet it with lubricating jelly or tap water, and insert the tapered tip of the obturator into the opening on the front of your neck. Then follow the curvature of the tube itself to slide it into positon. Do not “force” but “help” the tube tip to “find” its way into the trachea. This will make you cough.
  10. While holding the faceplate of the outer cannula in position flush with your neck so that you do not cough the tube out, remove the obturator.
  11. Fasten the ties or the Velcro strap.
  12. Insert the inner cannula.
  13. Position the tracheotomy sponge (slotted sponge) as appropriate.

Instructions For Tracheotomy Cleaning

  1. If not already done during the tracheotomy change (see #5 above), fill the basin you use for this purpose with l/3 hydrogen peroxide, and 2/3 tap water.
  2. Place the device to be cleaned into the basin. You will see foam begin to form.
  3. Use the tracheotomy brush to vigorously clean the inside of the inner or outer cannula. Insert the brush “both directions.” Use the side of the brush around the faceplate. If some material is adherent, soak for an hour or two and repeat.
  4. Once the tube is completely cleaned of adherent debris, rinse it off thoroughly with tap water, dry it with a clean towel, and place all three parts (outer cannula, inner cannula, and obturator) into a clean zip-lock bag. It is now ready to be used at your next tracheotomy tube change.

Tracheotomy Care: Mucus Plugs

Why do they occur?  

Usually because of: 

  1. Insufficient fluid intake/ Dehydration, causing thick or crusted mucus 
  2. Insufficient use of saline “squirts.”
  3. Insufficient cleaning of the inner cannula often enough. 
  4. Very low humidity, such as in Winter, in desert climes, or during long airline flights.  

How do we respond in general if mucus plugs are tending to occur? 

  1. Hydrate copiously (at least 8 glasses of liquid per day). 
  2. Use the saline squirts regularly and frequently. I usually say “not more than 50 times a day” to make the point that one can use many of these. 
  3. Use a bedside humidifier in the Winter, when it is very cold outside, IF the saline squirts are not worlking well enough. 
  4. Remove and clean the inner cannula more frequently to “stay ahead” of the mucus. 

How do we respond if there is a sudden (unexpected) mucus plug that is partial-just causing noisy breathing but no anxiety? 

  1. Cough a series of times. 
  2. Squirt some saline, and cough again (20 seconds or so). 
  3. Squirt again, and cough again (20 seconds or so). 
  4. Repeat 2 and 3 as many times as desired. 
  5. If you don ‘t produce the mucus and the noisy breathing continues, remove the inner cannula, run tap water through it and if that dislodged the plug, then replace the inner cannula. 
  6. If you can’t simply dislodge with running water, proceed to hydrogen peroxide and brush, rinse, and replace. 

What if there is a sudden, nearly complete blockage of the trach tube? 

  1. Remove the inner cannula. 
  2. If that resolves the problem, run tap water through it and if that dislodged the plug, replace the inner cannula. 
  3. If you can’t simply dislodge with running water, proceed to hydrogen peroxide and brush, rinse, and replace. 
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