A tracheostomy is a surgically created opening, called a stoma, made through the front of the neck and into the trachea. A hollow tube is placed into this opening to maintain a clear airway, allowing air to pass directly into the lungs and enabling the removal of secretions. Routine tube changes are necessary for hygiene and preventing complications, such as the buildup of secretions that can lead to a dangerous blockage or mucus plug. The outer tracheostomy tube must be replaced periodically because it is prone to colonization by bacteria and accumulation of mucus. This task is often performed by trained family members or caregivers in the home setting, but it requires prior medical instruction.
Essential Preparation and Timing
Thorough preparation is paramount for a safe and successful tracheostomy tube change, ensuring a clean and efficient process. All necessary supplies must be gathered and placed on a clean surface before beginning the procedure. These supplies include the new tracheostomy tube of the correct size with its obturator inserted, water-soluble lubricant, and a backup tube that is one size smaller in case of insertion difficulty. You also need a suction machine and catheters, an oxygen source or a self-inflating resuscitation bag, a syringe for deflating the cuff if applicable, and new securing ties or Velcro straps.
The timing of the first tube change is extremely important, as the tract between the skin and the trachea must be fully established to prevent a false passage. The initial change is generally not authorized until 7 to 10 days following the tracheostomy procedure. Subsequent routine changes are typically performed weekly or every two weeks, though some tube types may allow for changes up to every 28 days, depending on your healthcare provider’s instructions. The patient should be positioned comfortably on their back, with a rolled towel or blanket placed under the shoulders to slightly extend the neck. This positioning helps to bring the trachea forward, which improves the visibility and accessibility of the stoma.
Step-by-Step Procedure for Changing a Tracheostomy Tube
The physical process of changing the tube should be performed quickly and smoothly, often with two trained people present to ensure airway security. Begin by suctioning any secretions from the existing tube and from the airway above the cuff, if a cuffed tube is being used. If a cuff is present, a syringe is used to fully deflate it by withdrawing the necessary amount of air or sterile water.
Next, the new tube is prepared by applying a small amount of water-soluble lubricant to the tip to aid in smooth insertion. The old tracheostomy ties are loosened or cut while the first caregiver maintains a secure hold on the tube flange to stabilize the airway. On a pre-arranged signal, the old tube is removed gently, following the natural curve of the tube.
The stoma site can be quickly cleaned with gauze while the tube is out, removing any mucus or crusting from the skin opening. Immediately following the stoma check, the new tube, with the obturator securely in place, is inserted into the stoma with a downward and slightly curved motion. If any resistance is met, the tube should be removed and the patient’s position should be checked before attempting reinsertion.
As soon as the new tube is fully seated, the obturator must be swiftly removed, as the patient cannot breathe through the tube while it is inside. The new tracheostomy ties are then secured around the neck, allowing for one finger’s width of space between the strap and the neck for proper tension. If the tube has a cuff, it is reinflated to the prescribed pressure using the syringe, and the patient’s breathing status is confirmed.
Managing Immediate Complications and Safety Measures
The most serious complication during a tube change is the inability to reinsert the new tube, which can lead to airway loss. If the new tube cannot be inserted easily, a trained caregiver must not use force, as this risks creating a dangerous false passage into the tissue surrounding the trachea. The initial response is to immediately remove the tube, reposition the patient’s head and neck to better expose the stoma, and attempt reinsertion.
If the correct-sized tube still meets resistance, the smaller, backup tracheostomy tube should be inserted without delay. This smaller tube is more likely to pass through a narrowed or partially closed stoma tract, securing the airway. Another option is to use a suction catheter as a guide, passing it through the stoma into the trachea and then sliding the new tube over the catheter.
Signs of respiratory distress, such as cyanosis (bluish discoloration of the skin), severe coughing, or an inability to move air, require immediate intervention. If the airway cannot be secured quickly, emergency medical services must be contacted immediately. Any bleeding from the stoma site should be minor and easily managed with gentle pressure, but persistent or heavy bleeding requires urgent medical attention. Ensuring that all emergency equipment, including the self-inflating resuscitation bag, is always within arm’s reach is a fundamental safety protocol.