July 08, 2012

Tracheostomy Hand Book Part 4 - Trach Change

It is important to change a trach tube to prevent the build up of secretions and minimize the rick of accidental blockage and infection. Routinely the trach tube should be changed once a month, if infection is present or becomes obstructed/dislodged it should be changed immediately.

Special Considerations

  • Two people are needed for a trach change
  • It is important to remember that most children are able to breathe without the tube in. So there is no reason to panic and ruse through the trach change
  • The child should not eat for 2-4 hours prior to a tach change(unless in an emergancy) to minimize risk of vomiting.
How to change a trach tube


  • New tubes(usual size and one size smaller) and Obturator
  • Lubricant
  • New trach ties
  • scissors and Tweezers
  • wet cloth and dry cloths 
  • All emergency equipment
Preparing Equipment:
  • Wash hands
  • wet cloths
  • open new trach tube(make sure its the right one)
  • place obturator into tube only touching the hub or flanges(the part of the Trach that doesn't go inside the child)
  • lubricate the tip of the tube(the part that first goes into the stoma


Babies and toddlers often need to be laying down with a roll under their neck in order to visualize the stoma. Older children often prefer to sit up. Suction child first if needed.
  • Have assistant hold the trach tube and entertain the child 
  • cut and remove the ties
  • grasp the tube with your dominate hand and remove trach tube. (The action is similar to removing the gass nozzle from a vehicle)
  • Your assistant should wipe the soma with a clean cloth
  • With dominate hand insert the new tube(same as putting a gas nozzel into a car)
  • Remove the obturator while holding the flanges or hub securely
  • Clean and inspect skin and stoma same as with tie changes
  • Secure the new tube with ties
  • suction if necessary and observe child to ensure good airflow 


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