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Changing a tracheostomy tube can be very intimidating for many caregivers; however, with proper instruction, demonstration and practice, you will feel confident doing a tracheostomy change for your child.
Steps for a tracheostomy tube change:
1. Prepare needed equipment:
- Suction catheter and suction machine charged and in working order
- New trach tie (may be Velcro, a chain, fabric)
- New tracheostomy tube. Ensure correct size. Have a tracheostomy tube that is one size smaller in case the usual size does not go in easily.
- Water-based lubricant to prevent the tube from sticking to the skin as it is inserted
- Round-ended scissors
2. Wash your hands!
3. Prepare new trach tube. Take out of wrapping and hold by the flanges. Put in obturator (if applicable). Carefully apply a small amount of lubricant to the outer side of the tube, ensuring that no lubricant gets inside of the tube. Place the trach tie or strap on the new tube, hooked to one side. Place the tube back on the sterile or clean wrapper.
4. Before you begin, ensure that all of your equipment is in easy reach.
5. Suction, if necessary.
6. Position the child laying flat, with head tilted slightly back.
7. Have one person hold the tube while the other removes the old trach ties. And place new trach ties behind the child’s neck.
8. The old tube should continue to be held while the other person holds the new tube by the flanges and positions the tip near the child’s neck.
9. Gently remove the old tube following the curve of the tube.
10. Firmly and gently slide in the new trach tube, again, following the curve of the tube so as not to damage the trachea. Quickly and carefully remove obturator if this has been used.
11. Hold the new tube securely in place. Changing the trach tube could cause some coughing, which could dislodge the new trach tube.
12. Allow the coughing to settle, providing suction if needed. Check air flow through the tracheostomy tube by feeling the air flow in your hands and the patient’s breathing pattern and color. Again, suction as needed.
13. Clean and observe the skin around the tube.
14. Secure the new trach ties, ensuring 1-2 finger widths between the trach tie and the skin. Do not let go of the trach until the ties are secure.
Here is a video demonstration depicting a tracheostomy tube change:
Steps for a tracheostomy tube change:
1. Prepare needed equipment:
- Suction catheter and suction machine charged and in working order
- New trach tie (may be Velcro, a chain, fabric)
- New tracheostomy tube. Ensure correct size. Have a tracheostomy tube that is one size smaller in case the usual size does not go in easily.
- Water-based lubricant to prevent the tube from sticking to the skin as it is inserted
- Round-ended scissors
2. Wash your hands!
3. Prepare new trach tube. Take out of wrapping and hold by the flanges. Put in obturator (if applicable). Carefully apply a small amount of lubricant to the outer side of the tube, ensuring that no lubricant gets inside of the tube. Place the trach tie or strap on the new tube, hooked to one side. Place the tube back on the sterile or clean wrapper.
4. Before you begin, ensure that all of your equipment is in easy reach.
5. Suction, if necessary.
6. Position the child laying flat, with head tilted slightly back.
7. Have one person hold the tube while the other removes the old trach ties. And place new trach ties behind the child’s neck.
8. The old tube should continue to be held while the other person holds the new tube by the flanges and positions the tip near the child’s neck.
9. Gently remove the old tube following the curve of the tube.
10. Firmly and gently slide in the new trach tube, again, following the curve of the tube so as not to damage the trachea. Quickly and carefully remove obturator if this has been used.
11. Hold the new tube securely in place. Changing the trach tube could cause some coughing, which could dislodge the new trach tube.
12. Allow the coughing to settle, providing suction if needed. Check air flow through the tracheostomy tube by feeling the air flow in your hands and the patient’s breathing pattern and color. Again, suction as needed.
13. Clean and observe the skin around the tube.
14. Secure the new trach ties, ensuring 1-2 finger widths between the trach tie and the skin. Do not let go of the trach until the ties are secure.
Here is a video demonstration depicting a tracheostomy tube change:
References:
https://www.youtube.com/watch?v=nQJKU_tbPP0
http://www.uofmchildrenshospital.org/fv/groups/public/documents/images/103378.jpg
http://www.hopkinsmedicine.org/tracheostomy/living/change.html
https://www.youtube.com/watch?v=nQJKU_tbPP0
http://www.uofmchildrenshospital.org/fv/groups/public/documents/images/103378.jpg
http://www.hopkinsmedicine.org/tracheostomy/living/change.html