A tracheostomy tube, commonly called a trach, is an essential airway device inserted into the trachea through a surgical opening in the neck. The tube is held securely in place by a specialized strap or device known as a trach tie or tracheostomy securement device, which wraps around the neck and connects to the flanges on the tube’s neck plate. The primary function of the trach tie is to stabilize the tube and prevent accidental dislodgement, an event known as decannulation. Proper, routine replacement of this securement device is a foundational part of daily tracheostomy care, acting as a preventative measure against infection and complications.
Routine Change Schedule
The standard and most common recommendation is to change the tracheostomy ties daily, or at least every 24 hours, as part of the patient’s routine stoma care. This frequency is primarily driven by the need for hygiene and the prevention of skin breakdown under the device. Trach ties, whether made of fabric or a padded Velcro material, are highly susceptible to becoming soiled with respiratory secretions, moisture, and perspiration.
Secretions and moisture provide an ideal environment for bacterial and fungal growth, which can migrate to the stoma site and cause infection. Changing the securement device daily minimizes the time potential pathogens have to colonize the material. The material itself can also lose its structural integrity and supportive ability when consistently damp. The daily check and change remains the accepted protocol to ensure maximum security and cleanliness.
Identifying the Need for Immediate Replacement
The regular change schedule must be overridden if the tie shows any sign of compromise, requiring immediate replacement regardless of the last scheduled change time. Any visible soiling, such as mucus, blood, vomit, or food particles, necessitates instant removal because a contaminated tie poses a serious and direct infection risk to the stoma site. Dampness from excessive perspiration or water exposure must also trigger an immediate change, as moisture quickly promotes skin irritation and microbial growth.
The tie’s functional integrity must also be assessed; fraying, tearing, or any damage to the material can compromise the tube’s stability. Additionally, if the securement device feels too loose, risking accidental decannulation, or too tight, causing pressure injury to the neck, it requires immediate adjustment or replacement. A quick check for any signs of skin redness, chafing, or odor under the tie is a necessary component of this immediate assessment.
Step-by-Step Procedure for Changing Securement
Changing the securement device requires careful preparation and adherence to a safety-focused protocol to prevent the tube from coming out during the procedure. Before starting, all necessary supplies—a new tie, clean gloves, and a spare tracheostomy tube—should be readily available on a clean surface. The procedure is ideally performed using a two-person technique, where one trained individual holds the tracheostomy tube firmly in place against the neck by applying gentle pressure to the flanges.
The person performing the change should then carefully unfasten the old tie. A crucial safety rule is to never completely remove the old securement device until the new one is partially or fully secured to the tube’s flange, or until the tube is stabilized by a second person. Once the old tie is unfastened on one side, it can be gently pulled away from the neck. This allows for cleaning the skin under the flange and the tie path with a moist cotton swab or gauze, working from the stoma outward.
The new tie is then threaded through the flange opening on that side and secured, often using a Velcro tab or by tying a knot for fabric ties. This process is then repeated on the opposite side of the neck, ensuring the tube remains stabilized throughout. After the new tie is fully secured, the final and most important step is checking the fit. The tie should be snug enough to prevent movement but loose enough to comfortably allow one finger to slide between the tie and the patient’s neck. This one-finger-space rule ensures the tube is secure without causing dangerous pressure on the neck.
Preventing Skin Irritation Under the Ties
Maintaining skin integrity beneath the tracheostomy tie path is paramount for long-term comfort and infection prevention. During the securement change, the neck skin should be thoroughly cleaned of any residual secretions or moisture using water or saline, and then patted completely dry. Applying a dry, pre-cut split-gauze dressing, often called a trach dressing, under the tube’s flange can help absorb drainage and reduce friction against the skin.
The tie itself must be correctly sized and adjusted to the one-finger-space standard to avoid excessive pressure or chafing. A tie that is too tight can cause a localized pressure injury, while one that is too loose can move excessively and cause friction burns. In some cases, specialized barrier products, like certain hydrophobic ointments or skin protectants, may be applied to the skin under the tie path as directed by a healthcare provider to reduce friction and repel moisture. Regular inspection for any signs of redness, rash, or skin breakdown is necessary to identify and address irritation before it progresses.